The global rise of right-wing governments is threatening sexual and reproductive health (SRH) and LGBTQ rights – but human rights defenders and progressive donors are rallying to mitigate this.

US President-elect Donald Trump is expected to reinstate the Global Gag Rule that prohibits foreign NGOs who get US aid from providing or advocating for abortion on Day One of his presidency. His Defense Secretary pick, Pete Hegseth, is predicted to take action against transgender soldiers in the US Army. 

There will also be a substantial reduction in global aid for SRH and LGBTQ communities as Trump will end US support for these issues, both via the US Agency for International Development (USAID) and by reducing funding for UN agencies.

Several European governments that had stepped up during Trump’s previous presidency (2017-2021) to fund SRH and LGBTQ causes are now under right-wing rule and implementing aid cuts of their own. Others are overburdened with aid to Ukraine.

The Dutch government, now governed by a right-wing coalition, aims to cut its overseas development aid (ODA) by almost one-third next year. Grants to Dutch NGOs that dispensed much of the funds will be cut by 70%.

The Netherlands was the second biggest European donor for SRH, but it did not even mention SRH or LGBTQ issues in its mid-November announcement on development budget cuts. Under health priorities, it only mentions HIV and “preventing harmful cultural practices such as female genital mutilation, child marriage and harmful rites of passage to adulthood”.

In 2022, Sweden, under a centre-right coalition, cut its support for SRH by 17%, (168.5 million Euros) and is planning further cuts. However, it has maintained support for LGBTQ rights.

New LGBTQ funding

Days after Trump’s victory, ILGA, the international lesbian, gay, bisexual, trans and intersex association, held its biggest-ever international meeting in Cape Town, South Africa, vowing to act “in global solidarity against the ongoing anti-rights pushback”.

Shortly before the ILGA meeting, the first-ever Global LGBTI Funding Summit secured $100 million in new donor pledges for global LGBTI rights. But only three governments – Denmark, Germany, and Norway – have pledged so far.

“The Global Philanthropy Project (GPP) mobilized this campaign in response to seeing big risks to global LGBTI funding on the horizon,” GPP deputy director Ezra Nepon told Health Policy Watch.

“The US election results confirm and amplify those risks, and the $100 million in pledged new funds for LGBTI communities will be crucial to help resource and defend movements under attack. With the success of reaching our first pledge goal, GPP has extended the campaign to mobilize another $50 million in pledges by June 2025. Now is the time to step forward and commit big new resources for LGBTI movements and communities around the world.”

Germany and Mexico are co-chairs of the Equal Rights Coalition, a 44-country strong alliance of governments and NGOs formed in 2016 to protect the human rights of LGBTI people. Not a single African country belongs to the coalition although South Africa’s Constitution prohibits discrimination based on sexual orientation.

The work of the coalition takes place largely in thematic groups. The Netherlands, with NGO OutRight, heads international diplomacy efforts but its role is in question given its new right-wing government.

Democracy is not a ‘spectator sport’

Addressing the opening of the ILGA conference, Reverend Mpho Tutu-van Furth warned against assuming that the right to equality had been won.

“Complacency is a kind of drugged drowsiness. When we walk around assuming that what has been won will always be ours, we find that those wins are challenged or they’re eroded or they’re ignored,” said Tutu-van Furth, daughter of legendary anti-apartheid leader Archbishop Desmond Tutu.

“In South Africa, we swallowed that sweet syrup of complacency. Justice had won. Justice was done,” said Tutu-van Furth, now a pastor in the Episcopal Church as the Anglican Church withdrew her license to preach after she married a woman.

“We treated democracy as a spectator sport. Our ballot was the ticket to the game. Cast your vote and watch the government of the day do the best for you. But democracy is not a spectator sport, and your ballot is not a ticket to snooze in the stands. Your ballot is a permission slip that allows you to hold your elected representatives to account.”

Also addressing the ILGA Summit, Dr Alvero Bermejo, Director-General of the International Planned Parenthood Federation (IPPF), appealed for alliances to secure human rights.

“During the HIV crisis, there were strategic partnerships with very different partners,” Bermejo noted. “The space has shrunk. People are quick to call each other out on social media. But we need to re-create the space to make alliances.”

Rights are good for health

Depriving people of rights has negative consequences for health, particularly in the spread of sexually transmitted infections.

“Studies have consistently found that HIV policies grounded in human rights achieve superior results over those that are not rights-based,” UNAIDS notes in its annual World AIDS report released on Tuesday.

The UNAIDS #WorldAIDSDay2024 Report is out!

It shows we can end AIDS by 2030, if we protect everyone’s human rights.#EndAIDS

— UNAIDS Global (@UNAIDS) November 26, 2024

HIV prevalence is five times higher among men who have sex with men (MSM) in countries that criminalize same-sex sexual acts, according to UNAIDS, which has made “Take the rights path to end AIDS” its theme for International AIDS Day on 1 December.

“The human rights environment is deteriorating in many countries, and the commitment to multilateral efforts to address global challenges is often fraying,” the UNAIDS report notes.

“These trends are interconnected and threaten to undermine access to HIV prevention and treatment. Contexts that are experiencing democratic retrenchment are frequently those that are increasingly hostile to gender equality and the human rights of people from key populations.”

“Key populations” refers to those most vulnerable to HIV: sex workers, men who have sex with men, transgender people, prisoners and people who inject drugs.

Andriy Klepikov,  executive director of the Alliance for Public Health, one of the largest HIV and TB NGOs in Ukraine, describes the stalemate over human rights as “a war between ideology, prejudice and stereotypes on the one side and evidence-based science on the other side.”

“Countries like Russia are neglecting all the evidence [which shows] that the HIV epidemic is going up as a result of punitive law and repressive policies,” he told a World Health Summit event last year. 

Writing in the UNAIDS report, Elton John notes: “Shockingly, 44% of all new HIV infections worldwide are among women and girls. The risk of acquiring HIV is 23 times higher for gay men and other men who have sex with men than for people in the general population.”

Mpox vaccinations hindered

Mpox can also be sexually transmitted and “most of the cases that were reported in the multi-country outbreak in 2022/2023 were identified among gay, bisexual and other men who have sex with men,” according to the World Health Organization (WHO).

However, in the large mpox outbreak currently affecting Central Africa, only the Democratic Republic of Congo (DRC) is targeting MSM in its vaccination drive – and it can do so as it doesn’t outlaw same-sex relationships.

The DRC’s neighbours – Burundi and Uganda – are facing significant mpox outbreaks yet they are unable to reach this key group because they have outlawed all LGBTQ activities.

Likewise, banning abortion has never stopped women and girls from ending unwanted pregnancies. It has simply driven them to unsafe providers whose methods often maim and even kill them.

Unsafe abortions are a “significant and preventable cause of maternal mortality”, Dr Anu Kumar, CEO of Ipas, told Health Policy Watch.

Approximately 6.2 million women and girls had abortions in Sub-Saharan Africa in 2019, and the region has the highest rate of unplanned pregnancies and abortion-related deaths in the world – 185 maternal deaths per 100,000 abortions, according to  Guttmacher.

Polarised world

“In such polarised and contentious times, it has been heartening to witness so many people coming together, strengthening bonds to resist the anti-rights wave, and keep advancing the human rights of LGBTI peoples,” Julia Ehrt, ILGA World’s executive director, said after the conference.

“This conference has been a testament to the resilience, courage, and determination of our global movement. In Cape Town, we witnessed the strength of our unity, and we are inspired to continue working toward a world where everyone is free to live authentically and without fear.”

UNAIDS also notes that, “although the declining space for civil society in many parts of the world is alarming, there are places where space for civil society is expanding.

“In 2023, civic space opened up in more than 30 countries, including through judicial decisions, the release or acquittal of human rights defenders, or civil society policy victories,” it adds.

“We can elevate the human rights of all people living with or affected by HIV and end AIDS as a public health threat—or we can scapegoat, ostracize and punish the most marginalized people and watch the long-term human and financial costs of responding to HIV increase ever further,” UNAIDS concludes, calling on governments to fulfill their commitments to ending HIV.

However, the path ahead is rocky. Conservatives across the religious spectrum have formed strong alliances with right-wing politicians to ban abortion and promote the “natural family”, which is male-headed, heterosexual and has no space for LGBTQ people.

This alliance has deep pockets and is intent on rolling back a range of sexual and reproductive rights already won in international agreements, replacing them with documents such as the anti-abortion Geneva Consensus Declaration crafted during Trump’s presidency.

Trump’s US will become a poweful addition to the pushback against abortion and LGBTQ rights – currently led by at UN forums by Russia, Iran, Syria, Egypt and Nigeria.