除了捍衛生命權 (pro-life) 之外的任何東西
資料來源：www.thelancet.com/hiv 第 9 卷 2022 年 8 月 /財團法人台灣紅絲帶基金會編譯
性和生殖健康及權利對於抗擊愛滋病毒至關重要。對許多人來說，透過墮胎照護和其他性健康和生殖健康的接觸是愛滋病毒預防和治療的重要切入點。因此，美國最高法院推翻羅訴韋德 (Roe v Wade) 案、終止聯邦對墮胎取得的保護之決定，不僅會迫使許多婦女和女孩懷孕，包括強姦和亂倫的受害者，還會因不安全的墮胎而導致死亡。此舉還將阻礙美國終結愛滋病毒的目標。
1973 年的羅訴韋德 (Roe v Wade) 案和隨後的最高法院裁決確立了婦女在美國獲得安全和合法墮胎的權利。此後，這個問題變成了一場政治足球。儘管該國大多數選民都支持婦女獲得安全墮胎，但長期以來，很大一部分選民一直試圖推翻這項裁決。 6 月 24 日，最高法院由九名法官組成的小組（其中六名來自右翼；三名由前總統唐納德·川普在有爭議的情況下任命）裁定推翻羅訴韋德案。隨著法律的改變或被羅訴韋德掩蓋了半個世紀的過時法律重新生效，美國一半以上的州立即禁止或嚴格限制墮胎。
羅訴韋德案的推翻產生了突如其來且災難性的影響。在某些情況下，有些在等待程序的人被趕出診所。生活在所謂的墮胎沙漠中的人數突然地增加，讓他們遠離獲得墮胎照護服務達數百英里。同時，最高法院大法官表示他們打算修改其他影響易受愛滋病毒影響的弱勢和邊緣化人群的權利。
批評該決定的眾多機構包括美國傳染病學會和愛滋病毒醫學協會。國際愛滋病協會很快加入了他們的聲音：Adeeba Kamarulzaman 說，「對於許多個人和家庭來說，生殖保健是進入正規醫療保健系統的第一點，也是愛滋病毒預防、檢測和治療的關鍵環節」。舊金山愛滋病基金會表示，「最高法院推翻羅訴韋德案的決定不僅會阻止數百萬人獲得墮胎照護和生殖保健服務，而且還會為各州剝奪其他相關權利打開大門。身體自主權——包括避孕藥具、PrEP、同性婚姻的權利，以及安全使用藥物和減害資源的權利」。對墮胎權利的限制將不成比例地影響那些生殖保健獲得通常是其有效地去預防和治療愛滋病毒的進入途徑之群體。
影響不會僅在美國停止。例如，愛滋病領域中非常習慣於全球禁言規則（墨西哥城規則）的鐘擺擺蕩效應，該規則限制了美國政府向提供生殖諮詢和墮胎服務的組織支付其援助，包括美國總統愛滋病緊急救援計畫 (PEPFAR) 資金——在一場破壞性和乏味的政治乒乓球賽中，當共和黨政府領導時，規則被引入，而在民主黨政府統治時，它被撤銷。如果還不能確定，那麼未來共和黨領導的政府將不可避免地重新制定有害的政策。世界各國都寄希望於美國，最高法院的裁決將鼓勵美國以外之其他地方的國家尋求實施更嚴格的墮胎法。
自裁決以來，喬·拜登總統簽署了一項效果有限的行政命令，以保障獲得墮胎的機會，但這項措施被描述為總比沒有好，但幾乎等於沒有——更令人惱火的，因為拜登和前民主黨總統巴拉克. 歐巴馬都有機會將墮胎權寫入憲法，但從未採取行動。包括 Meta 和 Google 等巨頭在內的一些公司將支付員工進行墮胎的差旅和醫療費用，但這條路線不太可能為社會經濟貧困的人提供，這些人也最有可能處在感染愛滋病毒的風險下。
最高法院剝奪婦女和其他人安全墮胎權利的決定是一個倒退的舉動，將傷害許多人並阻礙控制愛滋病毒的努力。其他國家必須記取美國的這一教訓，並尋求保護自己的法律，以提供安全墮胎的機會並捍衛性健康和生殖健康及權利。我們支持對美國決定的批評，並支持那些尋求保護性和生殖健康的人。
（註）pro-life：墮胎是否合法？1973年美國最高法院對「羅訴韋德案」(Roe vs Wade)做出裁決，承認婦女的墮胎權，受到憲法隱私權的保護，使得墮胎在全美合法化。但法院也允許各州以立法的方式，對墮胎權加以限制。這也導致了此後幾十年，墮胎在美國始終是一個爭議重重、辯論不斷的政治話題。
公眾輿論圍繞這一問題吵得難分難解，但從根本上歸為兩派，也由此催生了墮胎議題中的幾個關鍵詞。
20世紀60年代，反對墮胎的一派創造了「pro-life」（捍衛生命權）的口號，以此強調對嬰兒生命權利的保障，即使他們未出生。Pro-life陣營常由保守人士組成，並在俄亥俄州、肯塔基州、阿拉巴馬州等共和黨執掌的保守州聲勢浩大。而支持墮胎自由的一派則呼籲「pro-choice」（捍衛選擇權），強調女性應有自由決定自己的身體、自由選擇墮胎的權利。
Anything but pro-life
www.thelancet.com/hiv Vol 9 August 2022
Sexual and reproductive health and rights are essential to the fight against HIV. And for many people, abortion care and other sexual and reproductive health contacts provide important entry points into HIV prevention and treatment. Therefore, the decision by the US Supreme Court to overturn Roe v Wade, ending federal protection for access to abortion will not only force pregnancy on many women and girls, including victims of rape and incest, and lead to deaths through unsafe abortions. The move will also hamper the USA’s aim to end HIV.
The 1973 case of Roe v Wade and subsequent Supreme Court ruling established a woman’s right to a safe and legal abortion in the USA. The issue has since become a political football. Although most of the country’s electorate are in favour of women having access to safe abortion, a substantial proportion has long sought to overturn the ruling. On June 24, the Supreme Court, a panel of nine judges (six of whom are from the right wing; three appointed by former president Donald Trump in controversial circumstances) ruled to overturn Roe v Wade. Access to abortion was immediately banned or severely restricted in more than half of US states as laws changed or outdated laws, masked for half a century by Roe v Wade, came back into effect.
The overturning of Roe v Wade has had precipitous and calamitous effects. In some instances, people awaiting procedures were turned out of clinics. The number of people living in so-called abortion deserts suddenly increased, leaving them many hundreds of miles away from access to abortion care. Simultaneously, Supreme Court Justices signalled their intention to revise other rights affecting vulnerable and marginalised populations disproportionately affected by HIV.
Among the many bodies to criticise the decision were the Infectious Diseases Society of America and the HIV Medicine Association. The International AIDS Society was quick to add their voice: Adeeba Kamarulzaman said that for “many individuals and families, reproductive healthcare is the first point of entry to the formal health care system and a critical link to HIV prevention, testing and treatment”. The San Francisco AIDS Foundations stated that the “decision by the Supreme Court to overturn Roe v Wade not only will prevent millions of people from being able to access abortion care and reproductive health care, but opens the door for states to strip away other rights related to bodily autonomy— including the right to contraceptives, PrEP, same-sex marriage, and the right to use drugs safely and with harm reduction resources”. The curbing of rights on abortion will disproportionately affect groups for whom access to reproductive health care is often a gateway to effective HIV prevention and treatment.
The repercussions will not stop in the USA. For example, the HIV field is very used to the pendulum swing of the global gag rule (Mexico City rule), which restricts disbursement of US Government aid, including PEPFAR funding, to organisations that provide reproductive counselling and abortion services—under Republican administrations the rule is brought in, under Democratic administrations it is revoked, in a damaging and tedious game of political ping-pong. If it wasn’t already certain, it is inevitable now that a future Republican-led administration will reinstitute the harmful policy. Countries around the world look to the USA, and the Supreme Court ruling will embolden others elsewhere to seek to implement more restrictive abortion laws.
Since the ruling, President Joe Biden has signed an Executive Order with limited effects to safeguard access to abortion, but the measure has been described as better than nothing, but barely—all the more galling since both Biden and former Democratic president Barack Obama had opportunities to codify the right to abortion in the constitution, but never acted. Some companies, including giants such as Meta and Google, will pay for employees’ travel and medical expenses to access abortions, but this route is unlikely to be accessible to socioeconomically deprived people in states with restrictive laws—who are also those most likely to be at risk of HIV.
The Supreme Court’s decision to strip women and others of their rights to safe abortion is a retrogressive move that will harm many and hinder efforts to control HIV. Other countries must heed this lesson from the USA and look to protect their own laws providing access to safe abortion and defending sexual and reproductive health and rights. We add our voice to the criticism of the US decision, and to the support for those who seek to protect sexual and reproductive