PHR Library

Leading Health Professionals Urge President Bush to Not Expand Mexico City Doctrine

Dear Mr. President:

We write to express our concern about reports indicating that you are considering regulations to expand and extend the “Mexico City” doctrine to include all reproductive health programs, including HIV/AIDS treatment and prevention programs. Reports, including a February 11 State Department memorandum, indicate that an expanded policy would prohibit funding for foreign nongovernmental organizations that “perform or promote” abortions. Such groups that implement “discrete” HIV/AIDS projects would continue to be eligible for funding for such programs.

As health professionals with experience in prevention, care, and treatment of HIV/AIDS, we strongly advise against placing such a bureaucratic burden on foreign nongovernmental organizations which are on the front lines of HIV/AIDS education and prevention. In HIV/AIDS- affected countries, existing clinics, prevention and education sites, hospitals, and testing facilities are already heavily overburdened with the immense task of preventing transmission of HIV/AIDS, and treating those with the disease. Every day, 15,000 people are newly infected with this deadly disease – many of them women and girls, who have no ability to protect themselves from violent, unwanted, or unsafe sex. Existing prevention programs are already behind the curve of new AIDS transmissions. Requiring groups that offer significant HIV/AIDS prevention services who may also be using non-U.S. government funds to provide legal abortions or information about them, to duplicate their staff, facilities, or administration is a potentially a wasteful and burdensome requirement that could impede such groups’ effectiveness in responding to the AIDS pandemic.

We are deeply concerned that the Administration may propose that AIDS programs be “discrete” from other health services in order to continue receiving U.S. government funding. Most poor women’s access to any health services is limited to family planning or maternal health programs, which can be important sources of information about HIV/AIDS, as well. The AIDS epidemic is so vast and the consequences for those who are exposed to the disease so deadly that people should be encouraged to obtain prevention education and supplies wherever they are available. One of the most important obstacles to successful HIV/AIDS prevention programs is the stigma associated with the disease that deters people from being tested, or receiving counseling, prevention supplies, or health care. In some societies, women who are known to have HIV/AIDS stand to lose homes, livelihood, and even their children. Given the high degree of stigma and ostracism that people with AIDS face in much of the world, for prevention programs to be successful, they must be integrated into services that people are accustomed to accessing, including family planning and maternal health services. Stand-alone AIDS programs, which the proposed policy may require, will be a significant setback in the integration and expansion of HIV/AIDS prevention and treatment initiatives that are so desperately needed.

We strongly urge you to oppose any expansion of the Mexico City “gag rule” into the broader realm of reproductive health, including HIV/AIDS programs. The pandemic is developing much faster than the international response to stop it. Impediments such as those currently under consideration by the White House run counter to best practice in HIV/AIDS prevention and general public health.

Sincerely,

Holly G. Atkinson, MD
President, Physicians for Human Rights
New York, NY

Lucy Bradley-Springer, PhD, RN, ACRN
President, Association of Nurses in AIDS Care
Denver, CO

Mardge Cohen, MD
Director of Women’s HIV Research
Cook County Hospital
Chicago, IL

James Curran, MD, MPH
Dean, Rollins School of Public Health
Emory University
Atlanta, GA

Frank Davidoff, MD
Editor Emeritus
Annals of Internal Medicine
Wethersfield, CT

Joseph J. Eron, Jr., MD
Associate Professor of Medicine
University of North Carolina, Chapel Hill
Chapel Hill, NC

Joyce J. Fitzpatrick, PhD, MBA, RN, FAAN
Elizabeth Brooks Ford Professor of Nursing
Case Western Reserve University
Cleveland, OH

Donna Futterman, MD
Director, Adolescent AIDS Program, Childrens Hospital at Montefiore
Professor of Clinical Pediatrics, Albert Einstein College of Medicine
Bronx, NY

H. Jack Geiger, MD
Logan Professor of Community Medicine, Emeritus
City University of New York Medical School
New York, NY

Ashley T. Haase, MD
Regents’ Professor and Head, Department of Microbiology
Director, AHC Biomedical Genomics Center
Director, Minnesota Division, Great Lakes Regional Center for AIDS Research
University of Minnesota
Minneapolis, MN

Martin Hirsch, MD
Infectious Disease Associates
Massachusetts General Hospital
Boston, MA

Peter Lamptey, MD, DrPH
Senior Vice President
Family Health International
Arlington, VA

Robert Lawrence, MD
Associate Dean for Professional Education and Programs
Edyth Schoenrich Professor of Preventive Medicine and Professor of Health Policy
Johns Hopkins University Bloomberg School of Public Health
Baltimore, MD

Allan Rosenfield, MD
Dean, Mailman School of Public Health
Columbia University
DeLamar Professor of Public Health and Professor of Obstetrics and Gynecology
New York, NY

Linda Rosenstock, MD, MPH
Dean, University of California, Los Angeles School of Public Health
Los Angeles, CA

Jane G. Schaller, MD
Karp Professor Emerita of Pediatrics, Tufts University
President, International Pediatric Association
Boston, MA

Ronald Waldman, MD, MPH
Professor of Clinical Public Health
Mailman School of Public Health, Columbia University
New York, NY

Andrew Wiznia, MD
Director, Family Based HIV Services and Pediatric HIV Services
North Bronx Healthcare Network
Professor of Pediatrics, Albert Einstein College of Medicine
Bronx, NY