Advocates Say Defunding Planned Parenthood Will Set Back HIV Efforts, Point to Indiana HIV Outbreak as Evidence

On July 14, anti-choice group Center for Medical Progress released the first of several heavily edited videos suggesting that Planned Parenthood illegally collects and sells fetal remains to medical researchers. Although the national reproductive health group has debunked those claims, the videos have reignited a push among conservative lawmakers to defund the reproductive health provider -- an outcome that would affect access to HIV and sexually transmitted infection (STI) testing, and strain a health care system already struggling to serve those populations most affected by HIV.

Uncut Video Supports Planned Parenthood's Rebuttal

The original video shows anti-choice activists, posing as biotech professionals, discussing fetal tissue donation with Dr. Deborah Nucatola, Planned Parenthood's senior director of medical services, during a lunch meeting. The actors, working for the Center for Medical Progress, press Nucatola about whether the health provider profits off of fetal tissue. Nucatola, whom the actors secretly filmed, rebuffs the notion.

The California-based Center for Medical Progress claims that the video -- the product of an apparent years-long investigation of Planned Parenthood -- proves that the clinic is "selling aborted baby parts." Planned Parenthood has dismissed the allegation, noting that the organization doesn't receive monetary benefit from donated tissue, but will sometimes be reimbursed for associated costs, such as shipping.

The anti-abortion group's raw footage supports Planned Parenthood's position. In the nearly three-hour unedited version of the initial nine-minute video, Nucatola discusses tissue donation only in relation to Planned Parenthood's work and tells the actors that "nobody should be 'selling' tissue."

A Renewed Call for Defunding

Nevertheless, the damage has been done. Since the first video's release, lawmakers have renewed calls for Planned Parenthood to be defunded. GOP presidential hopefuls Wisconsin Governor Scott Walker, Louisiana Governor Bobby Jindal and former Florida Governor Jeb Bush have boasted of defunding or seeking to defund Planned Parenthood in their state budgets and pledge to do so nationwide if elected. Fellow Republican hopefuls Mike Huckabee and Rick Santorum are promising to do the same.

Some Republican governors, including Jindal, have attempted to slash the funds by cutting off federal Medicaid funding for Planned Parenthood services in their states, which the Obama Administration recently warned could violate federal law. Earlier this month, the U.S. Senate blocked a Republican bill to pull federal funding for the health provider.

What Defunding Planned Parenthood Means for HIV

For anti-choice activists and lawmakers, defunding Planned Parenthood means ending abortion. But abortion services make up only 3% of the health care services Planned Parenthood provides. If Planned Parenthood loses funding, the over five-million people who rely on its services would lose access to affordable reproductive care, including HIV testing.

"If Planned Parenthood were defunded, we would lose an important community resource for HIV screening and access to reproductive health services for low-income women living with HIV," said Naina Khanna, executive director of the Positive Women's Network-USA, via email.

The Centers for Disease Control and Prevention estimates that in the U.S. more than 1.2 million people age 13 and older are currently living with HIV. That number includes over 155,000 people who are unaware of their status, the agency reports.

In other words: Almost one-in-eight people living with HIV don't know they're infected.

"Planned Parenthood is critical in terms of providing HIV screening for women, men and youth who may be at risk for HIV and might never walk into an HIV testing facility," Khanna said.

According to Planned Parenthood's latest annual report, in 2013 STI testing and treatment accounted for 42% of health services administered at about 700 Planned Parenthood centers. Contraception came in second, making up 34% of its services.

That same year, Planned Parenthood performed over 700,000 HIV tests.

The CDC recommends that people 13 to 64 years old be screened routinely for HIV, and that those at high risk of infection be tested annually. Losing access to Planned Parenthood services would result in a large number of people going untested, which could have severe implications for a community -- or even a state.

The Closing of Planned Parenthood and the Scott County HIV Outbreak

One example is the case of Scott County, Indiana. Beginning in December 2014, this small rural county, with a shrinking population of just under 24,000, became the epicenter of an HIV outbreak -- the worst HIV epidemic in Indiana history. By July, state health officials put the number of HIV cases in southeastern Indiana at 175.

"This was really an unprecedented large outbreak," said Jennifer Sherwood, policy associate for The Foundation for AIDS Research (amfAR), an international HIV/AIDS nonprofit.

While multiple factors contributed to the public health crisis, which occurred mainly among intravenous drug users, Sherwood said the 2013 closing of the Planned Parenthood clinic in Scott County played a large role. Planned Parenthood was Scott County's sole provider of HIV screening. When the clinic was forced to shutter its doors, the area was left without an HIV testing site for two years.

Four other Planned Parenthood centers have shut down in Indiana since 2011, mostly because of state budget cuts. That same year, the state's Republican-controlled legislature passed a bill defunding Planned Parenthood, which a federal judge blocked from enactment. Still, Indiana politicians continued to cut government funding and grants the clinic received.

"You often hear that HIV testing is a service that is provided elsewhere," Sherwood said, "but that's not really the case."

In Scott County, for example, only recently has the local health department filled the testing gap created by Planned Parenthood's closure. If Planned Parenthood were to be defunded completely, more acute HIV outbreaks like the one in Indiana aren't out of the question, Sherwood said.

Straining an Already Insufficient System

It's not only a matter of communal impact . If Planned Parenthood were "to disappear overnight," Sherwood said, the existing health care structure would absorb some of the clinic's services, inundating an already-strained and insufficient system. People with existing barriers to health care -- such as the uninsured, undocumented immigrants, people working in the underground economy and adolescents -- would be left with little to no care.

"We know that health care coverage in our nation is inadequate, especially lacking in rural America," she said.

People living below the poverty threshold -- who account for 78% of Planned Parenthood's client base -- are at increased risk for HIV infection.. According to the CDC, the prevalence of HIV among people living in poverty is two-times greater than among people not living in poverty. People with annual incomes of under $10,000 have the highest HIV rates, the agency reports.

The poor are also least likely to have access to necessary health care, testing and medications. With HIV treatment costs ranging from $2,000 to $5,000 a month, care is unaffordable for many people living with HIV.

Although Planned Parenthood generally doesn't provide HIV treatment, it's an important resource for directing patients toward HIV-related care, Sherwood said. Nationwide, the clinics can steer low-income people living with HIV toward social services such as the federal Ryan White HIV/AIDS Program, or educate HIV-negative partners about pre-exposure prophylaxis (PrEP) -- a relatively new medication for blocking HIV transmission.

For vulnerable populations, Planned Parenthood serves as "an important and culturally relevant gateway" to HIV prevention, testing and care, Khanna said.

"Being diagnosed early provides an important opportunity for engagement in care and access to treatment, which we know can improve the health of people living with HIV and also reduce the risk of HIV transmission," she said.

Take away Planned Parenthood and you remove the ability of people living with HIV to get help, advocates agree.

"In the face of a lot of these barriers and complications that come with providing care, Planned Parenthood has found a way to fill that gap and provide trusting and quality health services," Sherwood said. "It's disheartening that this organization is under perpetual political attack."