Bonus Pod: Wait..The "Anti-Prostitution Loyalty Oath" was at the Supreme Court?

Note: For the purposes of this conversation, the shownotes and transcripts for this episode use the term ‘’prostitution” when referring to the Anti-Prostitution Loyalty Oath. This is because the term is explicitly used in the policy discussed in this episode. “Sex work” or “sex workers” are more appropriate terms to use. 

The Anti-Prostitution Loyalty Oath (APLO) is a provision that prevents foreign NGOs and international affiliates of U.S. organizations from using the President’s Emergency Fund for AIDS Relief (PEPFAR) funds in a way that “promotes prostitution or sex trafficking” and they must have an explicit policy opposing prostitution and sex trafficking. Keifer Buckingham, Senior Policy Advisor with the Open Society Foundations and Open Society Policy Center sits down to talk with us about how the recent Supreme Court ruling that protects APLO is ultimately stigmatizing, discriminatory, and harmful to the goal of fighting HIV/AIDS. 

The Anti-Prostitution Loyalty Oath (APLO) is a provision in the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003. This piece of legislation created PEPFAR. APLO essentially states that no funds may be used to promote or advocate for the legalization of practice of prostitution or sex trafficking. APLO also states that no funds may be provided to institutions or organizations that do not have a policy explicitly opposing prostitution and sex trafficking. Lastly, APLO dictates that, by accepting U.S. government funds, an organization agrees that it is opposed to the practices or prostitution and sex trafficking. U.S. organizations who receive PEPFAR funds and global funds that fight AIDS, tuberculosis, and malaria. 

This logic and language is already problematic—first and foremost, it is important to remember that sex work and sex trafficking are not at all the same thing. Secondly, the policy hurts global work in attempting to fight HIV/AIDS because it forces organizations to choose between U.S. funding and caring for vulnerable populations (including LGBTQI people and sex workers). Ultimately, the policy compounds and exacerbates lack of access to care, discrimination, stigma, and danger to sex workers around the world.

The APLO has been to the Supreme Court many times. When the government tries to force clearly identified foreign affiliates (that happen to be legally incorporated overseas), to abide by APLO, but not have U.S. entities do the same, it results in an evident hypocrisy and a violation of first amendments rights. This was the argument for the most recent Supreme Court case, but, unfortunately, the court ruled in a way that undermined the health and human rights of those around the world.

Links from this episode

Open Society Foundations on Twitter
Open Society Foundations on Facebook
Background on the Court Challenges of The APLO
More information on the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003.
More information on Agency for International Development v. Alliance for Open Society International
GLOBE Act in the House
GLOBE Act in the Senate

Transcript

Jennie: Welcome to RePROs Fight Back, a podcast where we explore all things reproductive health, rights and justice. I'm your host, Jennie Wetter, and I'll be helping you stay informed around issues like birth control, abortion, sex education and LGBTQ issues and much, much more-- giving you the tools you need to take action and fight back. Okay, let's dive in.

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Jennie: I'm your host, Jennie Wetter, and my preferred pronouns are she/her. So this week we got great news. Well, mostly great news. We finally got the Supreme Court decision on June Medical Services and we won. I was so worried that we would not win and it should have been like an obvious answer since it had just come up before the court four years ago, but I didn't have faith, but we won. But unfortunately, that is not the case we're going to talk about today. We're going to talk about the case that was decided immediately before June Medical and that's on the Anti-Prostitution Loyalty Oath. And that was the case we lost. Don't worry. We'll talk about June as soon as I can connect with Julie again. And we will have that conversation hopefully this week, but it's coming soon. Don't worry. So, you know, I'm just going to take a minute to talk about…it's important to say it is a win and we need to celebrate it, but it just means that things aren't going to get worse. Right this second, right? Unfortunately, that doesn't mean that all of a sudden everybody has access to abortion services. So many people already were struggling to either access care because of barriers like 24 hour waiting periods or having to travel really far to a clinic or can't afford it. This doesn't change any of that. It just means that it's not going to get exponentially worse today. So, you know, we need to keep fighting to ensure that people who need access to abortion are able to access it and that it's affordable and really fight to ensure that those vulnerable populations who already have a disproportionate lack of access to care--so low income individuals, the LGBTQ community, young people, Black people-- are able to access the care they need. And those are the people we need to be centering in this fight to ensure that they have access to services. We'll talk about all that more with June. That's not the one we're gonna talk about today. So, you know, this week, I am really excited to think about Hamilton coming out on Disney.

Jennie: Y'all, I'm really excited to see it again. And I don't, I think I've ever told the story and if I have, sorry, so I was really lucky and I was able to see Hamilton on Broadway and I've seen it in DC too, but I was able to see it on Broadway as well. And so this was like four years ago around my birthday. I just happened to be on Twitter or something at night. And I saw a tweet from the Hamilton account saying there was a new block of tickets going up at nine o'clock and it was like 8:58. I was like, Oh, let me get my wallet. And so I like scrambled and I was able to get tickets and I wasn't able to get tickets till November, but like whatever I got tickets, I just picked a random night, got tickets and was like, that was my birthday present to myself. And I was so excited. So fast forward, I meet a friend for dinner and we're walking to the theater and we get to the theater and this motorcade pulls up and I'm like, okay, like, oh man, I really hope it's not like Trump or something. Cause I think I forgot to say it was four years ago. So this was November, 2016. It was right after the election. And so I get into the theater and I'm sitting down and some of the young people behind me start talking and they're all excited, mostly young girls [saying] “I'm excited because the vice president is here” and I was like, oh my goodness, I'm at the show with Joe Biden. How amazing is that? I was so excited and then I hear them keep talking and they're like, “yeah, Pence is here.” And I was like, and all I could think was, don't say what you want to say. Don't turn around and tell them 1) he's the vice president elect, and 2) as women who are women-presenting people who have a need for reproductive healthcare, you should not be excited. No, there's nothing to be excited about. So this show Hamilton, you know, it's amazing, but going on that night, it was lightning in a bottle. So what you hear reported often is that the crowd booed Pence. And I mean, obviously I booed. I mean, he's someone who gets up every day fighting against everything I get up fighting for. So yes, I booed, and no regrets. And then you hear about the amazing speech that the cast gave at the end, which was magical, but less covered is it was the whole show, felt like a protest. You know, the show uses a lot of revolutionary language and like a lot of things that I think, you know, get like big cheers on a normal night, just the crowd was electrified. So was the cast and we all used, it has a moment to make our voices heard and it was so cathartic to be able to do it with him there. So, you know, everything like, it just, it was so great and lightning in a bottle. So I know I will never re-live the magic of that particular show, but I'm really excited to see it again because it was really magical that night. And I don't really know what else to say about it other than it was really something I needed after the week before, which was the election. So it was a lot of fun. And so that is the memory I always have when I think of Hamilton was being there that night, to voice my concerns. And whether that's, you know, cheering my head off when Angelica talks about including women in the Declaration of Independence or any other things, it just, it felt good to do it. And to have him hear how excited we were and then to have the cast give such an amazing speech directly to him about the need to represent all of us, the diverse people in America really was…it felt good. So with that, let's turn to this week's episode and I am really excited to have Keifer Buckingham on. She is with the Open Societies Foundations and the Open Society Policy Center. She is amazing and it was a great interview and I can't wait for you all to hear it. Hi Keifer. Thank you so much for being here today.

Keifer: Hi Jennie. It's so great to be with you.

Jennie: I'm so excited to have you on it's been way too long without having you.

Keifer: It really has. I'm obviously a huge fan of the show. And since I'm back from parental leave, now we can finally get down to it.

Jennie: So Keifer can you take a quick second and introduce yourself, including your pronouns.

Keifer: Yeah. Hi, my name is Keifer Buckingham. I use she/her pronouns. I am a senior policy advisor in Washington, DC for the Open Society Foundations and the Open Society Policy Center.

Jennie: Okay. So there's a lot going on and like the big news yesterday, I guess Monday, cause this will probably come out on Wednesday, was June Medical Services, but that wasn't the only important repro Supreme Court decision yesterday.

Keifer: Right? I mean, I think it took a lot of the space up and rightfully so…

Jennie: But I guess before we get to the case, we haven't talked about the anti-prostitution pledge very much at all on the podcast… kind of only in passing. So I think it's a good time to do some level set. So what is the Anti-Prostitution Loyalty Oath?

Keifer: Right. So this thing also has lots of names. So maybe we can say what we're going to call it, cause I think that's helpful. We're going to call it the APLO because that's easier. Right? So the APLO is the Anti-Prostitution Loyalty Oath…by the way, “prostitution” is not our term we're using it because you know, it happens to be in the policy for the purposes of this conversation. We're going to say the word “prostitution” a lot, but that is because that's, what's actually in policy, we'll kind of switch back and forth from “sex workers” and “sex work” and “prostitution”. But just noting that when we say “prostitution” in this case, we're, you know, we're using that as a legal term and that's what's in legislation. So I also want to just say that.

Jennie: Absolutely. Good level set because that is something we've been trying to be really intentional with on the podcast is language.

Keifer: Right? Obviously, I mean, you know, the term is stigmatizing and you know, it reflects frankly the kind of the nature of the policy, right? It's old, it's outdated, which we'll get to later on, but the APLO is also known as the Anti-Prostitution pledge and in legal documents, for those of you nerds who want to like read through all the cases it's also referred to as the pledge requirement or the policy requirement. So that's the thing that we're going to be talking about today, but that's a very sort of basic level. The APLO is a provision in the United States Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003. So that's a total mouthful, but that is the piece of legislation that created PEPFAR or the President's Emergency Plan for AIDS Relief. So I think a lot of your listeners are familiar with this program, especially those who are familiar with that kind of global reproductive health space. It really is this amazing program that the U.S. government runs that spends billions of dollars each year on preventing and treating HIV. Right? So that's the, again, very sort of short version, but including that piece of legislation that created this program was this provision. And it essentially says that no funds may be used to promote or advocate the legalization or practice of “prostitution” or “sex trafficking.” So let's stop there. First of all, “prostitution” and “sex trafficking”, they put in the exact same line, right? So a lot of folks out there cringe at hearing something like that. So they're not the same thing obviously, but the government frequently conflates the two. And I think we've talked about other, you have had folks on who talked about some of that. So it's super problematic at its very core. The other part of this law says that no funds may be used to provide assistance to any group or organization that does not have a policy explicitly opposing “prostitution” and “sex trafficking”. So again, super problematic. And then lastly, it sort of said that by accepting funds from the U.S. government and NGO or public international organizations, agrees that (and its sub awardees) agree is that it is opposed to the practices of “prostitution” and “sex trafficking”. So I'm gonna pause there. It's like a lot to unpack, but essentially there's two pieces, right? One is that you can't use funds to actually do anything, to promote the legalization of, you know, we would say “sex work” or “sex trafficking”. And then you have to explicitly say, right, you have to say that, oh, by the way, we oppose these things. So it's kind of ridiculous. You know, there's lots of folks who would say, yeah, of course we oppose sex trafficking. Like that's a bad thing, but they're in the same sentence as quote unquote “prostitution”. So this policy has been around since 2003. PEPFAR--this legislation has been reauthorized three times since it was created in 2003 and this policy has been maintained each time. It has been reauthorized. So it's been around since then. It has not been repealed. Lastly, there are a couple exceptions to this policy as to sort of who must abide by it. And as we'll talk about next, that includes U.S. organizations who received, you know, these specific PEPFAR funds. And it includes the Global Fund to fight AIDS, TB, and Malaria, which is the largest kind of multilateral donor in the space around fighting HIV, the World Health Organization, and any other UN agencies. These multilateral agencies are only exempt from part of the policy, and that is the part that says that they have to explicitly have a statement, opposing the practices of “prostitution” and “sex trafficking”. They still have to provide by the other part, which says you can't use U.S. funds to promote or advocate for the legalization for practice “prostitution” and “sex trafficking.” So that's a lot. Yeah. So that is the entire prostitution pledge or APLO in a nutshell.

Jennie: So that is a lot. And to us it might seem pretty logical like why that is important when talking about HIV and AIDS prevention, but let's talk about it. How does this impact HIV/AIDS work?

Keifer: Right? I mean, first of all, we know that it has something to do with it because it was included only in this specific law. So to be clear, you know, you've talked about global gag rule and other policies in this podcast before-- this policy is only as it relates to these specific PEPFAR funds, right? So we're only talking about this policy as it applies to our fight against HIV globally, right? And to put it quite simply, it really negatively impacts our ability to fight HIV. And the policy literally hurts our work that we're trying to do. And is frankly at odds with other, you know, sort of stated goals that the U.S. government has put out there and that Congress has put out there right around reducing infections or increasing access to care and including sort of access to care for quote unquote “key populations,” which kind of means, you know, in this case, we're talking about folks that are uniquely vulnerable to HIV and to the impacts of the epidemic. And that includes LGBTQ people and sex workers, right? So it's just super antithetical to the broader goals that we set out for ourselves as a U.S. government in fighting this epidemic globally. So on the ground kind of what that means is that they all those sort of forces groups to make this impossible choice, right? Do you sign the pledge and thus receive U.S. money and you kind of sort of abandon sex workers and their families because you're not allowed to do this work? And there's this kind of chilling effect that kind of keeps organizations from even interacting with and serving sex workers because they're afraid of losing their U.S. funds or the flip side, you don't sign the pledge and you miss out on this very lucrative U.S. government money for HIV. And at the end of the day, you know, the U.S. remains the largest bilateral donor in the fight against HIV. So that's a lot of money we're talking about. And unfortunately, you know, in many places that are sort of hardest hit by the HIV pandemic, the U.S. funded clinic may be the only game in town, you know, and I think that, and again, referring back to what we know about the global gag rule, you know, if there's that one clinic there that folks can go to access care, but if you're afraid that you're going to be stigmatized or discriminated against, you're not going to go to get that test or to pick up condoms. Right? So that's really what we're talking about here. Research has shown that moral rejection and criminalization of sex work really does create an environment where sex workers are even more vulnerable to violence and abuse and therefore consequently at much greater risk of contracting HIV. So what I'm trying to say here is that this policy compounds and exacerbates kind of what already exists out there for sex workers, right? I mean, lack of access to care, you know, discrimination, stigma, and this U.S. policy is making it worse. Frankly, the last thing I'll say is, you know, I used to work on Capitol Hill. And one of the things that members of Congress talk a lot about is outcomes, right? Like what is the U.S. taxpayer getting for their money? This program PEPFAR is billions of dollars. They want outcomes, right? How many infections have we prevented? How many lives have been saved? This policy continues to serve really as a tremendous barrier to the U.S. implementing what we know is best practices for preventing HIV infection and detrimentally effects PEPFAR programs effectiveness. So at the end of the day, those outcomes that we strive for the various benchmarks that we have set for ourselves, and that Congress has set aren't being reached because the communities most affected, aren't getting the care they needed. And the organizations that are best suited to work with sex workers and their families are not the ones getting the funds. You can see where this really adds up to be a really harmful practice.

Jennie: Absolutely. And you know, a lot of those groups may have refused PEPFAR money and then got hit with global gag rule.

Keifer: Right. Oh my gosh. Totally. Right. It's like this compounding factor upon factor of this sort of harmful U.S. influence of these policies. So it's really is yeah, you're right. Like a double whammy that we see on the ground.

Jennie: Okay. So we know what it is. We know it's bad and really fighting against our stated goals of reducing HIV. So I know that there has been a big fight about it and over its constitutionality this week is not the first time that the APLO has gone to the Supreme Ccourt. So I guess let's talk about the first time it went to the Supreme Court. What was that case about?

Keifer: Right. So, and to be clear, I'm not a lawyer, but as you say, I play one on TV, right. I know just enough to be dangerous. So I'm sure your avid listeners will sort of critique as needed, but I have been, and many of other, my friends and colleagues have been really ingrained in this battle for really over 16 years. I mean…

Jennie: That’s crazy…

Keifer: …oh my god. I know, right. I mean, when this case was decided by the Supreme Court in 2013, which I'll talk about next, there was actually a whole backstory to that even before then. Right. Obviously starting with when the law was passed in 2003, but really back to 2005, when the Alliance for Open Society International, which is my organization, first filed a challenge against the policy. So it's been that long that we have gone back and forth in the courts. And so it really is this battle that we fought now, which to, you know, an unfortunate conclusion here this week, but something that our coat plaintiffs and that the larger global health community has fought against really across three different administrations, which is crazy to think about. So what I'm going to talk about is the 2013 ruling, but I'm sure there are folks out here who are really interested in kind of what was the back and forth and appeals courts and injunctions and all that. … But for the purposes of this discussion, some of you may even remember, and I was even talking to a couple of staffers on Capitol Hill when this was coming up at the end of last year. And they said, well, wait, did the Supreme Court [already rule on this], you know, I'm getting some deja vu and I'm like, you're not wrong. That did happen.

Jennie: And the decision came down this week and the same day.

Keifer: Isn't that crazy? Absolutely. Yeah. So in 2013 there was a 6-2 ruling. And this was so there were eight justices because Justice Kagan recused herself from the case because she had actually been working for the government at the time. So rightfully recused herself. So 6-2 ruling, not too shabby. Right. And it was in our favor. I mean, and Justice Roberts wrote the opinion and it was a great opinion essentially held that the APLO violates U.S. organizations first amendment rights, because it compels as a condition of federal funding. The acclimation of a belief that by its nature cannot be confined within the scope of a government program. Okay. So that's like legal speak, but I wanted to quote it because I think it's very important. Remember when I talked about those two different parts of APLO, there was a part there that actually compels an organization to say something. So that's really clearly a violation of our first amendment, right? And the court rightly saw that and very clearly and strongly in the opinion… they don't really clearly say you absolutely cannot compel speech again, that is outside of this piece, around to government program, which in this case is PEPFAR. So we want, I mean, that was a huge victory. And leading up to oral argument, we even had numerous members of Congress, you know, senators and representatives who had helped author the original PEPFAR legislation. We're talking about Republicans and Democrats, by the way, file amicus brief in support of our casing, the way that the government was implementing the policy was in no way, kind of the author's original intentions. When they wrote the bill, we also had a lot of support from conservative organizations and defensive first amendment rights. So again, it was a huge win and we thought that it should be over, but we were wrong. Obviously, we were very wrong. And that's where we get into what has led up to what happened yesterday.

Jennie: Right. So yay, good news. And then things didn't go exactly. As you thought they would. So that led to round two. So what was the fight over in this case?

Keifer: Yeah, I mean, well, it started pretty immediately after the Supreme Court made their ruling, right. We were like, we go to the government, we're like, hey, you're going to change all your, there are these things called standard provisions. Okay. That sort of, you know, when you get a word from the government to implement a program, you sort of sign all these legal things. And most of its very benign and boring, but they have a couple policy requirements in there. Of course, you know, if the global gag rule is enforced, that is in there, right? In this case, the intimacy and the loyalty and the government, it was sort of putting this in the contract language. And we were kind of like, sorry, but it was this ruling and you don't get to do that. So in 2014, after really more than a year of issuing official communications regarding government funding, that still contained the policy requirement with no exemption for our plaintiffs. So in this case, you know, you have, at this point, Pathfinder International, Global Health Council Interaction, others who had joined the government finally issued a nonbinding, interim guidance. That sort of stated that U.S. NGOs okay, fine, are not required to have a policy opposing “prostitution”. So again, let's be clear. I'm saying that the government lawyers took a year after this very clear, strong ruling to even be like, okay, you're right. U.S. NGOs don't have to have this policy. And that's oh yeah, we're talking about, I mean, this is 2013. So to be clear when I said three administrations, this is, you know, this is Bush and Obama. And now Trump, I mean, god, you know, many of us appreciated [the Obama] administration, but unfortunately we kind of got screwed from that administration. And in this case, legal team, you know, council that was continuing to just really dig their heels in and not do what we, what we interpret as the Supreme Court very clearly told them they had to do so again, in 2014, they finally said, okay, fine, sure, but at the same time, they also announced that the government will apply this policy requirement or the APLO to all foreign NGOs, including the plaintiff's affiliates. So that's where we got into a huge issue. This is the issue now, and this is the question that was before the court, this term. And that was the scandal Monday. We argued that when the government tries to force our clearly identified foreign affiliates, that happened to be legally incorporated overseas because as I'll talk about, sometimes they had to be forcing them to abide by this policy. But of course, not our U.S. entity, because again, that's unconstitutional. It forces us into what the court calls an evident hypocrisy, right? That, you know, you're forcing us to talk at both sides of our mouth that the U.S. entity would never say something that you are now telling our Kenya office, right. Or our international affiliate, or, you know, whatever the circumstance may be to say something in order to receive U.S. funds, that's a huge issue.

Keifer: And frankly, still a violation of our first amendment rights. So a good example, I think like there is even in the domestic space, we'll be familiar with organizations like World Vision, Save the Children and CARE, right? These big organizations that implement U.S. government programs, you know, on behalf of the American people that save lives that do really good work on maternal child health. And in this case on HIV/AIDS, in order to do work in other countries, oftentimes they have to have a legally incorporated entity in that country in order to do the work. Right. Sometimes it's the local government. Let's say the government of Kenya requires you to have the right legal entity there. Sometimes even the U.S. government has said, hey, we really want to work with local partners. And those organizations want to hire local experts to do the work, right. That's good practice in terms of good public health. You want to hire folks from inside the community to do the work and do the programs…But now you're saying that you require those organizations that by the way, have the exact same logo, right? They have the exact same color scheme. Everyone in that country knows them as Save the Children and World Vision, not some separate entity, but you're asking us to act differently. And that was the big issue is that we said by doing that, you're really still violating our first amendment rights. So that's where we that's really where the rubber hits the road. And that's what launched in 2014. So it was our back and forth. Permanent injunctions were issued and there were appeals and all that. And finally, the government essentially asked the Supreme Court to look at this last fall. And that's where we are today. We had a whirl-wind of arguments in March and it was decided on Monday. And so we really clearly asked the court, you know, we, weren't talking about first amendment protections for foreign entities. We were just simply saying, this is about the first amendment rights of these American organizations. And for those out there who are more familiar with the way that global health and foreign aid implementation works, those folks I think will be very familiar with like, oh, well, yeah, of course you have to have these like legal entities abroad. But at the end of the day, we act and speak with one voice. And so asking us to do something that is different than that is therefore a violation of our free speech rights. So sounds a little complicated, but really when you get down to it, it's quite simple.

Jennie: One organization, even if you have to be filed different…

Keifer: Right? Like if I'm a, you know, in a very technical, legal standpoint, but everybody else sees us as one body, right? And OSF is a good example, right? Open Society Foundations, you know, we're very large. We have offices all over the world, but we all want, and CARE is the same way. And Save the Children and World Vision. People don't know the difference between a World Vision Kenya and World Vsion that happens to be incorporated somewhere in the U.S., they know them as this great organization that does good work and public health and other places. So essentially at the time of the, and I just want to say this though, at the time of the prior decision, the 2013 decision, the Supreme Court was forced on enforcement against respondents themselves. So in our case plaintiffs, right, the court also addressed the harm to respondents that would result if the affiliate had to make a pledge. So in fact, we would argue that the court in 2013 already kind of decided this issue, but the government was able to, you know, they thought that they had enough room to sort of bring this back to what is frankly, now a much more gameable court, right. To their case. So, unfortunately what happened yesterday in a 5-3 ruling, and this will be a case that happened right before June Medical, right? So yesterday for me was just this total whiplash because you know, those of us who work on reproductive health, reproductive rights and justice, you know, we were watching both of these cases very closely. So it was, it was so bizarre to have this kind of whiplash, so glad that we ended with June, right? Like kind of the happy part. So we lost, I mean, frankly, you know, this case was a loss for us…And the majority went straight. So what is frankly quite narrow in cynical argument that the government took, which was first amendment protections don't extend to foreign organizations or foreign entities, like that's where the majority went, which frankly is not at all. Like, you know what we were arguing. Of course, we weren't asking for that, that would represent a dramatic expansion of first amendment rights. That's not what we're talking about. And frankly, that this sort of dissenting opinion that was led by Justice Pryor and joined by Justice Sotomayor, and Ginsburg said it really well. It said this case is not about the first amendment rights of foreign organizations. It is about, and has always been about the first amendment rights of American organizations. So that is obviously we agree with that opinion and that sentiment. So it's an unfortunate, it's definitely an unfortunate loss. You know, this 16-year saga is quote unquote over. But as I think we'll talk about, it's not really right. Like we have other actions that we can then take, so what is this going to mean on the ground? Well, I think a lot of this, frankly, Jenny goes back to kind of what we talked about earlier. Maybe a low has already been in place, you know, all through this argument, as it relates to foreign organizations, even take a step back from the question that was before us here, which was around foreign affiliates of U S organizations, the fact remains that this has been applied to all foreign NGOs since 2003. That's a tremendous amount of impact. We have already sort of talked about how the ATLO harms our battle against HIV globally and diminishes the effectiveness of existing programs and how the policy already sort of stigmatizes sex workers and has chilling effects beyond the policies sort of quote unquote intended scope. Right? I think what this case really means on the ground, we're going to have to see, because a lot of the organizations that I mentioned earlier that folks will be familiar with, have to now think about how they deal with this, right? How do their Kenya affiliate or their Malawi affiliate, how do they decide if they're going to then quote, unquote, take the pledge and how was the U.S. entity gonna sit with that? Because it's not something that they would say, or of course would be forced to say, because again, it's unconstitutional. That's going to be really interesting to see how that plays out, moving forward. But we know that the policy in and of itself is already super harmful. And this is just going to make it worse because those who are best suited to provide these programs are not going to be the ones doing the work, right. Or if they do do the work and quote, unquote, sign the pledge, how are they going to be able to serve those who are most in need? You know, and that's the important part, right? Like this is all wonky and talking about policy, but it's about the people who need the services Aa the end of the day, that's the whole goal. That's why we're spending billions of dollars. It's why Republicans and Democrats for decades now, right--remember PEPFAR was a Bush policy that came together across the aisle--that's why we do this work is because we think it's worth it. And we think that it's worth spending the money because it's the right thing to do because, you know, making sure that people have access to care and that we defeat HIV is what we're trying to do at the end of the day. And frankly like this policy keeps us from getting there. I mean, many other policies…prevent us from getting there. But it's just another example, right. Are these harmful U.S. policies that put aside, frankly, the violation of kind of human rights and these other, like really bad things, but also like literally doesn't achieve our public health goals. Yeah. So it's, it's sort of mind boggling in some ways, especially when you had so many members of Congress who said in 2013, what we meant, like we didn't, you know, we didn't want to really do that.

Jennie: You know, what actions can listeners take? So how can this be fixed?

Keifer: Yeah. So I think it's important to say at the end, just really reiterate that the same fact is true as it was in 2013 when the Supreme Court ruled that the APLO was unconstitutional. And again, also when Congress passed the law and created PEPFAR in 2003, this policy is dangerous and should be permanently repealed. Right? For all the reasons that we talked about today, we've been talking about kind of like the nuances of who has to abide by it and who doesn't. But at the end of the day, the whole thing is bad. You know? So once you get rid of it, period, the one thing that people can do is there's actually only one piece of legislation currently introduced in Congress that actually repeals the APLO permanently. And that's the GLOBE Act. The GLOBE Act is a bill that represents kind of a comprehensive framework for U.S. foreign policy that is inclusive of, and really responsive to LGBTQ people around the world. So it's an awesome piece of legislation that the LGBTQ and reproductive rights community came together and introduced last year. And so that's one thing you can do, right? You could call your representative or Senator, unless you, unless you live in DC and then, you know, sorry. Right. And ask them to cosponsor the legislation and or urgent consideration. Right? So that's one thing that people can really do right now. They're talking about how bad his policy is. And more broadly how bad these U.S. policies are that really sort of export this harmful us ideology, that's anti-gender and anti-abortion anti-sex work, right. Part of a broader movement that I know your listeners really care about…So like you have no excuse. You could totally make a phone call today or send an email because not a lot of people sitting in those offices that listen to Jennie’s podcast. We've mentioned this a little bit today. They're not the same, but there's a lot of similarities between the global gag rule, AKA Mexico City policy, AKA the Protecting Life Informed Assistance policy. There's a lot of interesting similarities, right? One it's unconstitutional, if it were applied to U.S. organizations, right. Two, it's contrary to public health, best practices, as you all have talked about on the show. Three, it's antithetical to stated U.S. policy goals of reducing maternal mortality and morbidity, and four, it exacerbates the impact of already vulnerable groups like sex workers and LGBT people. Right? So those similarities are there. So frankly the global gag rule should be repealed too. Right? Like I think if we're going to have this conversation around APLO we can't not mention the global gag rule.

Jennie: And they are different policies as I saw on Twitter. Some people getting them confused.

Keifer: Yeah. And that was killing me yesterday. I think what's important to note is while there's all these similarities, they're different. Right. You know, the global gag role of course, you know, by executive action, but there is a bill in Congress that would permanently repeal it. Right. And so that's the Global HER Act, which I know that you all talked about on here. So that's another example. I think of how those who are interested in trying to get these really harmful policies, differently, impact health and human rights around the world, off the books. That's something that folks can really kind of do any times, you know, that we should continue to be sort of telling our representatives if you need to be taking these up and that, you know, something that, that they should be concerned about.

Jennie: Perfect. I think that feels like a good place to stop. We have good actions people can take. Keifer, thank you so much for doing this.

Keifer: Oh my gosh. Thank you so much for having me. It was really fun. Glad I finally got to be on this awesome podcast and here's to many more, you've done a great job and I appreciate this awesome service you're doing for our community.

Jennie: All right, everybody. Thanks for listening again. Hopefully I will get the June Medical episode up soon. This week, I'm working on it. We're trying to find a time to get the interview scheduled and the episode up as soon as I can get the interview done. So it's coming. And as of when I'm recording this, which is Tuesday, we are still waiting on the birth control decision. And once we have that decision, I will have Mara back on to talk about what the court decided and what that is going to mean for people trying to access birth control.

Jennie: Thanks for listening everyone. And we'll see you on our next episode of RePROS Fight Back. For more information, including show notes from this episode and previous episodes, please visit our website at reprosfightback.com. You can also find us on Facebook and Twitter at RePROS Fight Back, or on Instagram at reprosfb. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

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