To End a Plague by Emily Bass

Author:Emily Bass [Bass, Emily]
Language: eng
Format: epub
Publisher: PublicAffairs
Published: 2021-07-06T00:00:00+00:00

PEPFAR THE POLITICAL BEAST was always different from PEPFAR the program “on the ground” in the countries where it operated. The past five years had seen both subversion and implementation of the program’s strictures on women’s sexual and reproductive health. On the one hand, nurse midwife Michele Moloney-Kitts, one of the early “Unprincipals” who’d remained on the PEPFAR team, and other US-based staff urged the country teams to consider ways to integrate contraceptive programming: USAID could buy the supplies; PEPFAR programs could pay for provider training, even if the program didn’t deliver the services.40 But over the same five-year period that PEPFAR funds had soared, USAID funding for family planning had flatlined.41

South African AIDS activist Yvette Raphael saw the ways that PEPFAR-funded programs negotiated the politics of family planning when, in 2007, she took a middle-management position at a PEPFAR-funded communications project run by Johns Hopkins University. In her job interview, she’d announced that she’d like to be running the organization, or an equivalent, within five years. When she got to her monitoring and evaluation qualifications—the skills she’d honed at the gun-collection program—the white man interviewing her told her to stop. She was hired.42

By this time, Raphael had been working with Americans for years on the “underground” system that shared donated medications, treatment literacy materials, and activist strategy. She’d imagined PEPFAR would be an extension of that work. “When I came into the system with the American people I was actually shocked that there were so many conditions for this funding,” she said. “It took me a while to understand and accept it as aid.”

She’d found a set of rules and regulations but also an organization that was willing to push the envelope—to a certain extent. In trainings she could provide information and address questions that fell in the realm of comprehensive sexuality education; she could also provide referrals to and information about abortion clinics if a young woman asked. “There were smart ways around it,” she said. She took notice of her boss’s posh home and ample household staff but concluded that, in spite of it all, he was “a good-hearted American white man doing stuff for South Africa.” The contradictions and compromises made her squirm, but it also seemed like the best option for fulfilling the mission—shared with Prudence Mabele—of making adolescent and young women’s lives better and safer. When she looked outside her organization, she saw “a denialist government and a denialist America.” Denial referred not just to whether HIV caused AIDS but to the fact that sexual and reproductive health were inseparable from HIV programs. Inside the PEPFAR-funded NGO, things looked better, though by no means perfect. She could see her boss “pushing the envelope, you know, but not too much, not to the detriment of the funding to the organization.”43

Back in Washington, DC, though, these nuances couldn’t be allowed to filter into the reauthorization. Dybul believed a bill aiming to expand the program’s investments in women’s health would never get passed, and when a draft

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