The CHANGE data index grades government agencies on policies and funding impacting family planning, maternal and child health, and HIV & AIDS foreign assistance.
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2021_American Rescue Plan Act (H.R.1319)
Signed into law by President Biden, the American Rescue Plan Act appropriated additional U.S. global health funding for specific implementing agencies to prevent, prepare for, and respond to the COVID-19 pandemic, as well as support public health surveillance to respond to other emerging infectious disease threats globally. It included contributions to support multilateral vaccine development partnerships and the Global Fund to Fight AIDS, Tuberculosis and Malaria. In this domain, the law appropriated additional funding for the Department of State to support global HIV and AIDS prevention, care, and treatment programs, as well as mentioned the need to mitigate the impact of COVID-19 on these programs. This action was responsive to need and based in evidence and human rights, though it was not gender transformative
. This law should have included a call for data to be disaggregated by sex and/or gender to inform responses to COVID-19 given the disproportionate impacts of the pandemic on women, girls, and gender-diverse people. This action moderately promoted SRHR in the HIV and AIDS domain.
2021_Executive Order on Establishment of the White House Gender Policy Council
This Executive Order (EO) detailed the Biden administration's commitment to gender equity and equality in the United States and globally. It established the White House Gender Policy Council to coordinate activities across the U.S. government (USG) that are related to advancing gender equity and economic security, combating discrimination, increasing access to health care, preventing gender-based violence (GBV), addressing the effects of COVID-19 on women and girls, and promoting SRHR. This action was based in evidence and human rights because it included a directive for the Gender Policy Council to develop and publish a gender strategy and create clear guidelines for reviewing current policies and programs and revoking those that did not align with the administration’s position on SRHR. It was responsive to need because it directed the Gender Policy Council to update outdated or harmful policies such as the 2020 Gender Equality and Women’s Empowerment Policy and the Strategy to Prevent and Respond to GBV, both of which were published by the United States Agency for International Development (USAID). This directive to the Council acknowledged the specific needs of “underserved communities” and extended the focus of these efforts beyond women and girls, which demonstrated a commitment to enacting gender transformative
policies by addressing systemic biases and creating policies that advance equity. This action specifically mentioned the importance of promoting SRHR and laid the groundwork for the forthcoming whole-of-government strategy to advance gender equity and equality through specific global health programs, including HIV and AIDS programs. This action significantly promoted SRHR in the HIV and AIDS domain.
2021_Executive Order on Preventing and Combating Discrimination on the Basis of Gender Identity or Sexual Orientation
This EO stated the goal of the Biden administration “to prevent and combat discrimination on the basis of gender identity or sexual orientation” and directed USG agencies to revise, suspend, or rescind any actions that were not consistent with the administration’s nondiscrimination policy. It instructed all heads of agencies to create additional actions as needed to implement the policy to combat overlapping forms of discrimination, including race and disability. This EO was responsive to need and consistent with human rights because it sought to address actions implemented during past administrations that discriminated against people because of their gender identity and/or sexual orientation, which is a violation of people’s human rights. It also directed heads of USG agencies to develop plans to carry out the requirements of this EO within 100 days of the Order, which was actionable and responsive to need. This action was gender transformative
as it affirmed people’s gender and sexuality, and aimed to prevent discrimination across all USG agencies, which was responsive to need and based in evidence. Though this action did not explicitly mention global health programs such as those related to HIV and AIDS, the whole-of-government approach to combating discrimination moderately promoted SRHR in this domain.
2021_Executive Order on Tackling the Climate Crisis at Home and Abroad
This EO outlined President Biden's plan to prioritize the climate crisis in U.S. policy. It confirmed the re-engagement by the United States with the Paris Agreement and called for USG agencies engaged in international work to develop implementation plans that integrate climate considerations into their work, which was responsive to need. It established the National Climate Task Force to "facilitate the organization and deployment of a Government-wide approach to combat the climate crisis." Though this action was generally responsive to need because of the urgent imperative to respond to climate change, it did not discuss the direct impacts of climate change on specific sectors within health, including SRHR. As it relates to SRHR, this action was not based in evidence because it did not mention the impact of climate change on SRHR outcomes, including for people living with HIV (PLHIV). It also did not explicitly mention the human rights frameworks that would guide the USG’s response to climate change though there was a strong emphasis on environmental justice and the disproportionate impact of climate change on specific marginalized populations, which was based in evidence and responsive to need. The EO was gender blind as it did not mention the disproportionate impact of climate change on women, girls, and gender-diverse people. Though this was a critical step in addressing the climate crisis, SRHR was not meaningfully included as a cross-cutting issue so this action neither promoted nor hindered SRHR in the HIV and AIDS domain.
2021_Fact Sheet_Advancing Disability Inclusive Democracy in the United States and Globally
This Fact Sheet detailed the commitments made by the Biden administration to prioritizing "disability inclusive democracy" globally across the Federal government. The White House appointed a U.S. Special Advisor on International Disability Rights and expressed support for novel projects and partnerships, which includes global health programs managed by USAID. The goals of these projects were to develop inclusive international health systems that provided assistive products for people living with disability and support people who have been impacted by COVID-19 through quality, equitable, and inclusive teaching and learning tools. Notably missing from this action was a directive to incorporate disability rights in SRHR and global HIV and AIDS programming, making this action only somewhat based in evidence and responsive to need in the HIV and AIDS domain. While the inclusion of people with disabilities strengthens democracy and promotes human rights, there was no mention of gender in this action, which was gender blind. As a result, this action only moderately promoted SRHR in this domain.
2021_Fact Sheet_President Biden’s Global COVID-19 Summit_Ending the Pandemic and Building Back Better
This Fact Sheet detailed the commitments made by the Biden administration at the Global COVID-19 Summit, which included enhancing equitable global access to vaccines, increasing treatment options for people with COVID-19, establishing sustainable health security to prevent and respond to future pandemics, and aligning global targets to end the COVID-19 pandemic. This action mentioned leveraging investments made by PEPFAR to strengthen health systems, infrastructure, and the healthcare workforce to support COVID-19 screening, testing, and vaccine readiness efforts while continuing to address the HIV epidemic. The leveraging of resources was responsive to need, aligned with human rights, and based in evidence. However, this action was gender blind because it did not mention the disproportionate impact of COVID-19 on women, girls, and gender-diverse people. Additionally, the action did not mention cross-cutting issues such as GBV which have worsened during the pandemic. This action moderately promoted SRHR in the HIV and AIDS domain.
2021_Fact Sheet_United States to Announce Commitments to the Generation Equality Forum
This Fact Sheet outlined the domestic and global commitments made by the Biden administration at the Generation Equality Forum, including policy and resource commitments to prevent and respond to all forms of GBV, strengthen women’s economic security, and protect and advance SRHR. This action was responsive to need and based in human rights as it was rooted in the Beijing Platform for Action and aligned with global priorities, including those related to climate, science and technology, leadership and democracy, and education. It summarized the administration’s actions related to global health, such as revoking the Global Gag Rule (GGR) and restoring funding to the United Nations Population Fund (UNFPA), which were consistent with human rights, based in evidence, and responsive to need. It acknowledged the rise in GBV as a shadow pandemic during the COVID-19 crisis as well as the rise in anti-gender initiatives, which was highly responsive to need. The action emphasized the importance of combating harmful gender norms but used language that reinforced a gender binary, which excluded lesbian, gay, bisexual, transgender, queer, and intersex (LGBTQI+) people. This action called for doubling the annual investment in the PEPFAR DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) public-private partnership, which is a gender transformative
program to prevent new HIV infections among adolescent girls and young women (AGYW). As a result, this action significantly promoted SRHR in this domain.
2021_Memorandum on Advancing the Human Rights of Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex Persons Around the World
This Presidential Memorandum outlined the Biden administration’s policy to end violence and discrimination based on sexual orientation, gender identity or expression, or sex characteristics (SOGIESC) across the USG and around the world. It directed USG agencies that engage in international work to review and rescind policies that are inconsistent with the administration’s stance on this issue, which was responsive to need and supported the implementation of policies based in evidence and human rights. It was highly responsive to need as it directed "all agencies engaged abroad to ensure that United States diplomacy and foreign assistance promote and protect the human rights of LGBTQI+ persons," including in the making of funding decisions, which would include global HIV and AIDS programs. This memorandum was gender transformative
because it intended to combat harmful gender norms and end discrimination towards persons of diverse SOGIESC, but it was generally confined to implementation "as appropriate and consistent with applicable law," which could be restrictive depending on the country context. This action did not address the ways in which violence and discrimination are barriers to accessing comprehensive sexual and reproductive health (SRH) services, including safe and ethical HIV testing. This action moderately promoted SRHR in the HIV and AIDS domain.
2021_Memorandum on Protecting Women’s Health at Home and Abroad
This Presidential Memorandum stated that it is the policy of the Biden administration to “support women’s and girls’ sexual and reproductive health and rights in the United States, as well as globally." This action marked the first time that a U.S. administration has actively supported SRHR at the presidential level. This action was responsive to need, consistent with human rights norms, and based in evidence because it directed USG agencies to immediately waive the GGR (also known as Protecting Life in Global Health Assistance (PLGHA) or the Mexico City Policy), which the previous administration had expanded to apply to all U.S. global health assistance funding, including PEPFAR funding. Though immediately revoking the GGR significantly promoted SRHR, this action did not provide a timeline for suspending, revising, or rescinding any policies or actions that conflicted with the directives in this memorandum, including updating ongoing awards to remove the GGR provision, which was not responsive to need. This action withdrew the United States from the Geneva Consensus Declaration and directed USG agencies that were involved in foreign assistance programs to "ensure adequate funds are being directed to support women’s health needs globally," including SRHR services, which was highly responsive to need and based in evidence and human rights. While clearly advocating for global programs that provide women’s SRHR services promoted SRHR, limiting this action to "women’s health needs" was reductive and gender aware as doing so did not affirm the rights of all people to access SRHR services regardless of their gender or sex. The Memorandum did not mention access to safe abortion services as a priority for the administration, which stigmatized abortion services. Nevertheless, this action significantly promoted SRHR in the HIV and AIDS domain.
2021_Memorandum on Restoring Trust in Government Through Scientific Integrity and Evidence-Based Policymaking
This Presidential Memorandum stated the Biden administration’s policy to "make evidence-based decisions guided by the best available science and data" across the federal government, which was based in evidence and responsive to need. This action specifically directed USG agencies to "review and expeditiously update any agency policies, processes, and practices issued or published since January 20, 2017 that prevent the best available science and data from informing the agency’s evidence-based and iterative development and equitable delivery of policies and programs." However, solely focusing on updating anti-science policies from the previous administration was not sufficient, as the review should extend much further to ensure that policies being implemented today are based in evidence, regardless of when they were passed. This action directed USG agencies to develop scientific integrity policies that support policy making based in evidence and listed several approaches and methodologies that could inform this process, including qualitative research, community engagement, and social and behavioral approaches. While SRHR and global health programs were not explicitly mentioned, enforcing evidence-based decision making at all levels of government ultimately benefited global HIV and AIDS programs. This action moderately promoted SRHR in this domain.
2021_Memorandum on Revitalizing America’s Foreign Policy and National Security Workforce, Institutions, and Partnerships
This Presidential Memorandum directed USG agencies to implement policies that revitalize the national security and foreign policy workforce and institutions under the core principles of integrity; transparency; diversity, equity, inclusion, and accountability (DEIA); modernization; service; and accountability. The Memorandum called for the creation of an Interagency Working Group on the National Security Workforce to ensure that workers are recruited and retained to promote the success of the programs implemented by USG agencies. The action required USG agency leadership to meet with partners on a quarterly basis, which promoted transparency
, though it did not include directives for transitioning power or funding to local partners, which was a missed opportunity to diversify the partner base. This action advocated for including a wide diversity of voices and perspectives in foreign policy, which was based in evidence and responsive to need. It also provided greater workplace resources to minimize staff burnout and turnover, which often impact the continuity of global HIV and AIDS programs. However, the Memorandum did not explicitly include directives or support for health care workers even though they are critical to ensuring national security and the success of U.S. foreign policy, especially global health assistance. The policy was gender accommodating as it included protections for all USG staff regardless of gender identity, including LGBTQI+ individuals, though it did not include measures to combat gender norms within the workplace. This action moderately promoted SRHR in the HIV and AIDS domain.
2021_Memorandum on the Presidential Determination with Respect to the Efforts of Foreign Governments Regarding Trafficking in Persons
This Presidential Memorandum restricted which forms of U.S. foreign assistance could be received by other countries depending on their compliance with the minimum standards for the elimination of trafficking in persons as defined in the Trafficking Victims Protection Act of 2000 (TVPA). The Memorandum stated that the USG will not provide "nonhumanitarian, nontrade-related assistance"—which includes global health assistance—to specific countries that do not meet these minimum standards, with some exceptions to allow for global health funding, as well as "development assistance that directly addresses basic human needs" on a country-by-country basis. This policy was not based in evidence or responsive to need as cutting off global health assistance for these countries could pose a barrier for survivors of trafficking to receiving essential care, including HIV and AIDS services. It was also not based in human rights norms, as it promoted a carceral approach to preventing and addressing trafficking, which relies on law enforcement to prevent and prosecute trafficking even though justice systems do not consistently protect the human rights and needs of survivors. The policy was gender blind as it did not explicitly recognize the disproportionate impact of trafficking on women and girls. Overall, by leveraging global health assistance as a tool to coerce compliance with TVPA, this action moderately hindered SRHR in the HIV and AIDS domain.
2021_National Action Plan to Combat Human Trafficking
The National Action Plan to Combat Human Trafficking outlined a roadmap for how the United States should address trafficking domestically and in foreign policy. The Plan focused on the four pillars of anti-trafficking efforts: prevention, protection, prosecution, and partnership, and emphasized a commitment to gender and racial equity, workers' rights, fair trade, and providing support to underserved communities. Regarding SRHR and other health outcomes, the Plan was largely domestically focused. It included provisions that applied to global health assistance, but global HIV and AIDS programs were not mentioned. The Plan was responsive to need as it recognized the disproportionate impact of trafficking on "racial and ethnic minorities, women and girls, LGBTQI individuals, vulnerable migrants, and others from historically marginalized and underserved communities." However, the Plan promoted policies that reduced demand for products or services from forced labor, which was not based in evidence as these policies often lead to the prosecution of sex workers and the violation of their rights. Other aspects of the Plan included centering the expertise of survivors and adopting inclusive policies for programs to decrease systemic disparities that negatively impact marginalized communities or increase their vulnerability to trafficking, which was responsive to need as well as based in evidence and human rights norms. While this action used language that enforced the gender binary, it also mentioned LGBTQI+ populations, making the Plan gender accommodating. Since the Plan's focus was mostly within the United States, it neither promoted nor hindered SRHR in the HIV and AIDS domain.
2021_National Strategy for the COVID-19 Response and Pandemic Preparedness
The National Strategy for the COVID-19 Response and Pandemic Preparedness detailed the Biden administration's interagency plan to promote pandemic recovery efforts across domestic and foreign policy. Goal 7, "Restore U.S. leadership globally and build better preparedness for future threats," contained the Strategy's specific initiatives related to foreign policy and global health assistance. The Strategy directed the creation of publicly accessible performance dashboards to establish an evidence-based approach to evaluating progress towards COVID-19 prevention and recovery, which was responsive to need and based in evidence. Even though it recognized the disproportionate impact of the pandemic on women and girls, this action was gender accommodating as it reinforced a gender binary, did not include LGBTQI+ persons, and did not challenge gender inequities that intensified as a result of the pandemic. The Strategy committed to promoting SRHR and included cross-cutting issues that have been impacted by COVID-19, including GBV, tuberculosis, and immunizations. It mentioned HIV as a secondary impact of COVID-19, though did not provide specifics of how HIV services were affected by the pandemic, or how USG programming would address this impact. The Strategy moderately promoted SRHR in the HIV and AIDS domain.
2021_National Strategy on Gender Equity and Equality
The National Strategy on Gender Equity and Equality detailed the whole-of-government approach to promote gender equity both domestically and globally. The Strategy laid out several plans to increase access to health care (including SRH services), advocate for gender equity and equal representation in leadership, and respond to GBV and climate change. The Strategy named the domestic and global promotion of SRHR as a priority. The Strategy called for the end of the GGR and promoted the provision of integrated SRH programs, which was responsive to need. However, it did not explicitly call on Congress to permanently repeal the GGR, which was a necessary action that would significantly promote SRHR globally. The action affirmed the right to access safe abortion care, which was responsive to need but only applied to the domestic implementation of the Strategy. The Strategy committed to working in partnership with "foreign governments and multi-lateral organizations, and non-governmental actors—including faith-based groups, civil society, and private sector organizations" using an intersectional approach to addressing discrimination and advancing gender equity, which was based in evidence and responsive to need. The action included a section on advancing human rights by working to eliminate practices that undermine gender equity, such as female genital mutilation/cutting (FGM/C), child and early forced marriage (CEFM), and GBV. Many aspects of the Strategy were gender transformative, such as the inclusion of people of all genders (i.e., transgender women and girls, gender nonbinary and nonconforming people, and men and boys) and the call for programs to implement cultural and gender norms change. While the Strategy recognized that sociocultural factors make women and girls more susceptible to HIV and AIDS, the action did not meaningfully include PEPFAR or specific global HIV programs that are gender transformative
and promote gender equity (e.g., DREAMS). The Strategy moderately promoted SRHR in the HIV and AIDS domain.
2021_Report on the Impact of Climate Change on Migration
This Report provided an overview of the impact of climate change on migration to inform a proposal for how United States foreign assistance could and should address the impacts of climate change on displaced persons. The Report included quality health services as part of the social services package that the USG could provide to partner governments that receive migrant populations, but it did not discuss access to health services for displaced persons in detail. The Report acknowledged the barriers faced by people related to intersectional forms of discrimination and named the expertise of agencies like the Department of State and USAID to provide technical guidance to integrate the unique needs of people with marginalized identities into foreign assistance. The Report stated that planning and policy decisions should include engagement with marginalized populations to ensure that funding and programmatic decisions were responsive to need. It emphasized the importance of multilateral engagement through the Sustainable Development Goals (SDGs), the Paris Agreement, U.N. resolutions, and the role of civil society, which was based in evidence and human rights norms and was responsive to need. However, the role of U.S. global health funding or programs, such as global HIV and AIDS programs, was not specified in the Report. The Report was gender accommodating as it recognized gender as a factor in the context of GBV, and included "women, girls, and gender diverse persons." This report neither promoted nor hindered SRHR in the HIV and AIDS domain.
2021_Strengthening Health Security Across the Globe_Progress and Impact of United States Government Investments in the Global Health Security Agenda
This Report detailed the progress and impact of the USG’s investments in global health security during fiscal year (FY) 2020. 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 mentioned HIV in the context of the Division of Global Health Protection Field Epidemiology Training Program (FETP) within the Centers for Disease Control and Prevention (CDC) as one of the issues addressed by the FETP. However, the Report did not include details to indicate why HIV and AIDS efforts were included in this intervention or explain the outcomes of this programming. Though the Report focused on global health security, SRHR and other cross-cutting issues such as 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 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 the COVID-19 pandemic. The Report was gender blind as it made only one mention of gender in the context of the OneHealth approach
. This action moderately hindered SRHR in the HIV and AIDS domain.
2021_U.S. COVID-19 Global Response and Recovery Framework
This Framework built upon the National Strategy for the COVID-19 Response and Pandemic Preparedness' Goal 7: "Restore U.S. leadership globally and build better preparedness for future threats." The Framework prioritized the dissemination of safe and effective COVID-19 vaccinations, addressing food insecurity, reducing GBV, and recognizing the impact of the pandemic on women and girls, youth, displaced persons, and underserved populations. It highlighted cross-cutting principles such as humility, multilateralism, partnerships, diversity, equity, and inclusion (DEI), evidence-based and risk-based decision making, transparency, and accountability. Through its focus on underserved communities and implementing systemic, fair, just, and impartial treatment of all, the Framework was based in human rights norms. While the objectives listed were based in evidence and responsive to need, the Framework did not name specific actors, deliverables, or timelines in accordance with the objectives, which was not responsive to need. The Framework acknowledged gender inequality and the importance of repairing the harm of the pandemic that worsened these inequities, which was gender accommodating. This Framework moderately promoted SRHR in this domain.
2021_U.S. International Climate Finance Plan
The U.S. International Climate Finance Plan outlined a whole-of-government approach to providing and mobilizing financial resources to aid other countries in recusing and avoiding greenhouse gas emissions and building resilience against the impacts of climate change. The Plan included improving human health as a positive impact of climate finance and directed USG departments and agencies that engage in global health to analyze the impacts of climate change on human health, which was responsive to need. The Plan called for USG agencies to align their partnerships and financial investments with what is needed to achieve the goals included in the Paris Agreement, which was based in evidence. The Plan also included time-bound and specific goals and deliverables that apply to USG agencies that would benefit global health assistance and programming, which was responsive to need. However, the Plan did not specifically mention the impacts of climate change on SRHR, including PLHIV, or the potential positive impacts of climate finance on promoting SRHR. The Plan mentioned women and girls but was otherwise gender blind as evidence indicates that climate change disproportionately impacts women, girls, and gender-diverse people around the world. This Plan neither hindered nor promoted SRHR in the HIV and AIDS domain.
2021_United States Government Women, Peace, and Security (WPS) Congressional Report_June 2021
The Women, Peace, and Security (WPS) Congressional Report provided Congress with an overview of progress 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, Department of Defense (DoD), Department of Homeland Security (DHS), and USAID: participation, protection, internal capabilities, and partnerships. While improved health outcomes were included as a positive impact of implementing the WPS Agenda, HIV and AIDS and the needs of women living with HIV were not meaningfully included. The Report included GBV prevention and programming as a cross-cutting measure of progress towards achieving the WPS Agenda, which was responsive to need. The Report emphasized the importance of evidence-based implementation and decision-making, and included specific and actionable milestones to measure progress, which was responsive to need. The Report included several gender transformative
elements such as enhancing gender-sensitive data analytics, recognizing "the intersectionalities inhabited by women," and supporting initiatives to address and overhaul harmful gender norms. However, it was predominantly focused on women which reinforced a gender binary. The Report moderately promoted SRHR in the HIV and AIDS domain.
2020_Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 (H.R. 6074)
The Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020 became law on March 6, 2020, and appropriated an additional $435 million in Global Health Programs (GHP) funds for the Department of State and United States Agency for International Development (USAID) to “prevent, prepare for, and respond to” the COVID-19 pandemic through September 30, 2022. This action was highly responsive to need because it was passed early in the pandemic and provided much-needed funds to support the initial global health response to the pandemic. The decision to appropriate additional funds to support pandemic response efforts was also based in evidence and human rights. This action moderately promoted the ability of U.S. global health assistance to support HIV and AIDS programs that could address the impacts of COVID-19 related to SRHR.
2020_Executive Order on Advancing International Religious Freedom
This Executive Order (EO) referenced foreign assistance funding for international religious freedom and directed the Department of State and USAID to prioritize religious freedom in the planning and implementation of U.S. foreign policy and within foreign assistance programs. The EO directed the Secretary of the Treasury to identify the economic tools that could be used to pressure other country governments to comply with this EO, including "realigning foreign assistance" though it was unclear how this could affect global health assistance programs. This EO was not evidence-based, responsive to need, or aligned with human rights standards as it prioritized religious freedom over evidence, global health needs, and human rights. Further, it was gender blind as it made no mention of gender and ignored the reality that religious freedom has been used in some settings to hinder gender equity efforts. The EO did not mention HIV and AIDS programs, nor did it consider how the directive might engage with other areas of global health, which contributed to the siloed approach to global health and resulted in a transparency
issue. This EO moderately hindered the ability of U.S. global health assistance to support HIV and AIDS programs that are evidence-informed, responsive to need, consistent with internationally-recognized human rights principles, gender transformative
, and promote SRHR.
2020_Executive Order on Combating Race and Sex Stereotyping
This EO directed recipients of federal grants to agree not to use federal funds for workplace trainings that promote "divisive concepts," such as "race or sex stereotyping." The EO specifically directed the Office of Personnel Management (OPM) to review training programs that were developed for agency employees to ensure compliance with this action. This EO was not based in evidence or human rights norms as it ignored the impact of white supremacy, systemic racism, and colonization on the health and human rights of Black, Indigenous, People of Color (BIPOC) communities around the world. Furthermore, the EO adhered to a gender binary and did not encourage a gender transformative
approach to discussing power and privilege based on race and sex. While this action did not provide technical guidance related to HIV and AIDS, it directed agencies to pose restrictions on the types of trainings that could be supported by federal funds for global health grants and cooperative agreements. Therefore, this EO moderately hindered the ability of U.S. global health assistance to promote SRHR in the HIV and AIDS domain.
2020_Executive Order on Ensuring Access to United States Government COVID-19 Vaccines
This EO dictated how COVID-19 vaccines should be distributed in the United States and abroad. It specified that vaccines should only be distributed outside of the United States upon determination that there was “sufficient” supply for Americans who “choose to be vaccinated.” It directed the Secretary of the Department of Health and Human Services (HHS), the Secretary of State, and Administrator of USAID to facilitate international access to COVID-19 vaccines developed in the United States, though it was unclear if U.S. global health assistance funds would be used to implement this effort. It specified that vaccines should be distributed to “allies, partners, and others, as appropriate and consistent with applicable law.” This demonstrated a vague and potentially inequitable approach to vaccine distribution during a global pandemic when solidarity is required to ensure equitable access to vaccines globally. This approach was not aligned with evidence or international human rights norms and was not responsive to need as this type of American exceptionalism is dangerous and deadly for those who live in countries that are not allies with the United States. It was also gender blind because it did not mention the disproportionate impact of COVID-19 on women, girls, and gender-diverse people, nor did it mention the impact that the global distribution of vaccines would have on women, girls, and people with diverse sexual orientation, gender identity, gender expression, and sex characteristics (SOGIESC). As a result, it moderately hindered the ability of U.S. global health assistance to promote SRHR in this domain.
2020_Executive Order on Rebranding United States Foreign Assistance to Advance American Influence
This EO directed federal agencies to ensure that all U.S. foreign assistance was marketed as “American aid,” and displayed logos and other imagery that “embod[y] the values and generosity of the American people. While this EO did not explicitly mention global health, it applied to all foreign assistance which included global health awards. At its core, this EO created a burden for recipients of foreign assistance to meet these marketing standards. It potentially hindered the ability of global health award recipients to provide health services to people in communities that have anti-American views, where “American aid” branding may be a deterrent or barrier to people seeking services. This EO prioritized the United States’ influence over ensuring that U.S. foreign assistance was evidence-based, responsive to need, and grounded in human rights norms. It was also gender blind because it made no mention of gender in the context of U.S. global health assistance programs. The lack of explicit mention of specific programs, including those related to HIV and AIDS, presented a transparency
issue given that the EO would apply to all global health awards. This EO moderately hindered the ability of U.S. global health assistance to support HIV and AIDS programs that were evidence-informed, responsive to need, consistent with internationally-recognized human rights principles, gender transformative
, and promote SRHR.
2020_President’s Interagency Task Force: Report on U.S. Government Efforts to Combat Trafficking in Persons
This report discussed U.S. government 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 relied 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 could 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 moderately hindered SRHR in the HIV and AIDS domain.
2020_Presidential Determination with Respect to the Efforts of Foreign Governments Regarding Trafficking in Persons
This Presidential Memorandum applied restrictions on the types of U.S. assistance permissible to different countries based on whether they were compliant with the Trafficking Victims Protection Act of 2000 (TVPA). Based on this memorandum, governments who did not meet the minimum standards for the elimination of trafficking in persons (as defined in the TVPA) would be barred from receiving U.S. non-humanitarian, non-trade assistance, which includes global health assistance. In the context of this policy, global health assistance was explicitly used as a diplomatic tool to pressure foreign governments to comply with the conditions of the TVPA. This policy was not responsive to need because cutting off global health assistance would act as a barrier for people engaged in sex work or people who are trafficked from receiving HIV and AIDS services in specific countries. It was not aligned with human rights norms because the minimum standards with which governments were being asked to adhere enforced a carceral approach to trafficking, which relies heavily on law enforcement to prevent trafficking even though these systems do not consistently protect the rights of marginalized groups that may be trafficked. This poses great risks to those engaged in commercial sex work as it creates barriers to accessing health services due to fear of prosecution or targeting from law enforcement. The Policy was also gender blind, as it made no mention of the impact of gender on its approach or determinations. This Presidential Memorandum hindered the ability of U.S. global health assistance to promote SRHR in the HIV and AIDS domain.
2020_Preventing Hoarding of Health and Medical Resources To Respond to the Spread of COVID–19
This EO directed the Secretary of the Department of Health and Human Services (HHS) to take action to prevent the hoarding of personal protective equipment (PPE) and other supplies to respond to the spread of COVID-19. This EO was intended to be a positive preventative measure by the White House to ensure that there was enough PPE available to those who needed it at the beginning of the pandemic, however the specification for what constituted ‘hoarding’ of PPE was vague and could be difficult to implement accurately. It did not mention gender issues or make accommodations for groups who are disproportionately impacted by COVID-19 like women, girls, and gender-diverse people. This EO contributed to confusion regarding what could be procured with U.S. global health assistance funds across implementing agencies and partner organizations. More information is needed on how funds should be used to purchase PPE and what constituted “hoarding.” The EO neither promoted nor hindered SRHR in the HIV and AIDS domain.
2020_The National Action Plan to Combat Human Trafficking
The National Action Plan to Combat Human Trafficking set the U.S. government’s priorities related to human trafficking. The Plan prioritized a “victim-centered, trauma-informed, and culturally competent” approach to supporting trafficking survivors in alignment with the standards set by the Office for Victims of Crime within the Department of Justice which were based in evidence. The Plan recognized that survivors of trafficking should be able to access comprehensive medical and mental health services, including those related to HIV and AIDS, but it conflated trafficking with sex work which was not consistent with evidence. This National Action Plan was not consistent with international human rights norms beyond the Palermo Protocol
because it was based on the Trump administration’s framing of unalienable rights. The Plan also promoted a carceral approach to trafficking, which is based on neither evidence nor human rights and jeopardizes the health and wellbeing of sex workers. The Plan mentioned that “people of all ages, genders, races, religions, and nationalities” including “LGBT+” individuals are disproportionately impacted by trafficking, which was based in evidence and was gender accommodating. This whole-of-government approach was primarily focused on domestic issues and programs, and it was unclear if the role of U.S. global health funding or programs were considered here, which was a transparency
issue. This Plan neither hindered nor promoted the ability of the U.S. global health assistance to support SRHR in the HIV and AIDS domain.
2020_Women’s Global Development and Prosperity Initiative_Annual Report 2019-2020
This report described the accomplishments of the Women's Global Development and Prosperity (W-GDP) Initiative in its first year of implementation. The Initiative was based on President Trump’s America First policy and was designed to support USAID’s work toward countries’ self-reliance. Though this was the first whole-of-government report about women’s economic empowerment, it reinforced the silos between economic empowerment and health because it did not include a discussion about HIV and AIDS or health more broadly. While gender-based violence (GBV) was mentioned, the Report made no mention of its connection to health, even though GBV is a cross-cutting SRHR issue. The Report called for removing “cultural barriers” to women's economic empowerment but did not identify the barriers or describe them, which contributed to low transparency. The Report was gender aware because it mentioned women's barriers to economic empowerment but reinforced a gender binary and did not acknowledge the needs of LGBTQI+ communities or others who might also benefit from economic empowerment efforts. Elements of this report were based in evidence and human rights, though details about health and SRHR were significantly lacking. Further, it was unclear if the W-GDP Initiative impacted or engaged with global HIV and AIDS programs during its first year of implementation because the types of funds used by this initiative were not explicitly mentioned, which is a transparency
issue. This report neither hindered nor promoted the ability of U.S. global health assistance to support SRHR in the HIV and AIDS domain.
2019_Global Health Innovation Act of 2017 (H.R.1660)
This law signed by the President instituted a new requirement for the Administrator of USAID to report to Congress about USAID’s investment in and development of novel global health technologies. The passage of this bill indicated White House and Congressional interest in global health technologies and implemented a mechanism to hold USAID accountable to continuous innovation of such technologies. HIV and AIDS technologies, unlike family planning technologies, were explicitly mentioned in the Act which provided an accountability mechanism for these specific technologies. The Act did not reference human rights principles or the need for more women and girl-centered technologies, such as multi-purpose prevention technologies that prevent both pregnancy and HIV acquisition. This law was responsive to need and evidence-based, as it emphasized the importance of global health technologies and innovation in achieving global health goals. Overall, this law promoted SRHR within the HIV and AIDS domain because it encouraged the development of technologies to support HIV and AIDS programming.
2019_United States Government Global Health Security Strategy
This document was a cross-agency Strategy to improve global health security both in the U.S. and globally. The Strategy discussed the importance of disease prevention and treatment and outlined the role of the U.S. and other funders invested in strengthening health systems in countries that may not currently have the capacity to respond to outbreaks. This Strategy was high-level and did not specifically discuss relevant global health issues, including HIV and AIDS. The annex of the Strategy mentioned the role of the President's Emergency Plan For AIDS Relief (PEPFAR) in ending the HIV and AIDS epidemic, however the discussion about HIV and AIDS should have been more consistent throughout the Strategy given the importance of this health issue to global health security. This Strategy was responsive to need and evidence-based, as it referenced global standards regarding global health security and data proving the need for strengthening of health systems throughout the Strategy. The Strategy was neither gender transformative
nor based in international human rights norms, as it did not discuss the role of gender norms in global health security or specifically reference human rights principles that frame global health security efforts. Overall, this Strategy’s silence on HIV and AIDS did not harm SRHR but it also did not promote SRHR. Future strategies should provide specific details about relevant programs that contribute to global health security, including HIV and AIDS.
2019_United States Strategy on Women, Peace, and Security
The U.S. Strategy on Women, Peace, and Security is the operationalization of the Women, Peace, and Security Act of 2017 and is intended to "increase women’s meaningful leadership in political and civic life by helping to ensure they are empowered to lead and contribute, equipped with the necessary skills and support to succeed, and supported to participate through access to opportunities and resources." However, the Strategy dismissed the important role of health in the wellbeing and participation of women and girls in decision-making processes and institutions both during times of conflict and peace. Given that the Department of State and USAID were named as relevant actors in this Strategy, the lack of discussion of health—specifically of HIV and AIDS treatment and prevention—was an obvious gap in the Strategy. The absence of health was further glaring given the documented impact of the breakdown of health systems on people living with HIV (PLHIV) in conflict and humanitarian settings. The Strategy also did not address the risk of sexual transmission of HIV due to gender-based violence (GBV) in conflict and crisis settings.
This Strategy was responsive to need as it addressed the lack of representation of women in conflict resolution and peacebuilding processes. However, the Strategy is not grounded in evidence as evidence shows the key role of health—particularly HIV and AIDS prevention, care, and treatment—in achieving country stability. The Strategy was not grounded in human rights, as the document cited "the United States Government’s interpretation of the laws of armed conflict and International Human Rights Law'' which may have implied that human rights principles were not being followed as written. Lastly, this Strategy was not gender transformative
because it recognized but did not take steps to address the root causes of gender inequity within conflict and post-conflict settings, nor did it advocate strongly for the inclusion of all populations in these efforts. It is possible that this Strategy, once implemented, could create avenues for significant gender transformation but this Strategy is narrow in a way that ultimately harms women and girls.
2018_Asia Reassurance Initiative Act of 2018 (S. 2736)
The Asia Reassurance Initiative Act discussed U.S. efforts to improve relations with countries in Asia and promote democracy and human rights within the region. These efforts were responsive to need and based in human rights principles, particularly related to reducing poverty and violations of human rights that have occurred within the region. However, the law was not gender transformative
or strongly evidence-based in HIV and AIDS prevention and treatment efforts. It mentions "reducing the HIV and AIDS infection rate” through the Lower Mekong Initiative (LMI), but provided no programmatic guidance on how to accomplish this. The LMI was launched in 2009 and is a multinational partnership among Cambodia, Laos, Myanmar, Thailand, Vietnam, and the U.S. to create integrated sub-regional cooperation among the five Lower Mekong countries. The LMI could serve as a promising platform for HIV and AIDS prevention and treatment efforts, but this could only be implemented if additional policy and technical guidance are released. The law also briefly mentioned supporting women’s equality, but did not discuss the importance of addressing gender-based violence (GBV) and sexual and reproductive health and rights (SRHR) in promoting democracy and human rights. Given the prevalence of GBV against ethnic and religious minorities in the region, this was a missed opportunity by the White House to address this issue. For these reasons, this law will likely only have minimal direct effect on the ability of U.S. global health assistance to support HIV and AIDS programs in the region.
2018_PEPFAR Extension Act of 2018 (H.R. 6651)
The PEPFAR Extension Act amended the PEPFAR Stewardship and Oversight Act of 2013 by extending the authorization of PEPFAR through FY 2023. The law allowed PEPFAR to continue its programming, which is largely evidence-based, responsive to need, and based in human rights norms. However, this law also maintained previous authorization language that is not gender transformative
and continued clauses that cause harm to key populations, such as the Anti-Prostitution Loyalty Oath and the refusal clause. With the reauthorization, the White House had the opportunity to revise these harmful aspects of the authorization of PEPFAR and chose not to do so. As a result, this law moderately promoted the ability of U.S. global health assistance to support HIV and AIDS programs that are evidence-informed, responsive to need, consistent with human rights principles, and gender transformative
2017_Presidential Memorandum of January 23, 2017_The Mexico City Policy (Expanded Global Gag Rule)
President Trump reinstated and expanded the Mexico City Policy, often known as the Global Gag Rule, and renamed it the Protecting Life in Global Health Assistance (PLGHA) policy. When in place under previous administrations, the policy applied only to international family planning assistance, whereas Trump’s version of the policy "extend(s) the requirements... to global health assistance furnished by all departments or agencies." Research has documented the harms of this policy in previous administrations when the policy was in effect, and the expansion of this policy via this 2017 Presidential Memorandum demonstrated a disregard for evidence and international human rights norms. This policy spurred a chain of events that significantly reduced community and government engagement in HIV prevention, care, and treatment programs and prohibits beneficiaries from accessing key services in many countries that receive U.S. global health assistance. The expansion of the PLGHA policy was against evidence, need, and human rights principles and was not gender transformative
; this policy was gender blind, as it did not discuss the role of gender norms on the promotion of SRHR through U.S. global health assistance programs.
2016_The United States National Action Plan on Women, Peace, and Security
The United States National Action Plan on Women, Peace, and Security described what the U.S. continues to do to empower women as equal partners in preventing conflict and building peace in countries threatened and affected by war, violence, and insecurity. The Plan moderately promoted SRHR by calling for better access to "clinical care and reproductive health services such as family planning, HIV testing, counseling, and treatment…" though HIV testing, counseling, and care was not discussed in further detail. The Plan did not explain the impact of access to HIV and AIDS prevention and treatment services on conflict prevention and country stability nor did it acknowledge the relationship between gender-based violence (GBV) in conflict and the prevalence of HIV and AIDS among women and girls. In fact, there was little discussion on any structural, cultural, and safety barriers that prevented women in conflict-ridden areas from accessing the HIV and AIDS care they wanted and needed. However, the Plan did discuss the intersections of HIV and AIDS with other sexual and reproductive health (SRH) issues, such as maternal mortality. Additionally, this plan is moderately gender transformative
as it called for more gender equality and inclusivity in all initiatives, especially regarding “members of marginalized groups, including youth, ethnic, racial or religious minorities, persons with disabilities, displaced persons and indigenous peoples, lesbian, gay, bisexual, transgender, and intersex (LGBTI) individuals, and people from all socioeconomic strata.” The Plan also discussed the distinct needs of ex-combatants and former violent extremists who are female, specifically stating that these women have a difficult time adhering to traditional gender norms upon their return from combat. However, it did not explicitly mention the disproportionate impact of HIV and AIDS on former combatant populations or other key populations such as female sex workers or people who inject drugs (PWID). This National Action Plan supported the U.S. government's ability to promote SRHR with regard to HIV and AIDS programs and funding.