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    What is the Pepfar fight and what does it mean for Africa?

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    What is Pepfar and why is it in the news?Pepfar is an acronym for the US “president’s emergency plan for Aids relief”. It was set up two decades ago by George W Bush to address the HIV epidemic.It’s the biggest government-run fund of its kind. Since 2003, the project has donated about $110bn (£90.5bn) to governments, universities and nonprofits in 50 countries, either directly or through agencies such as USAid.Until now Pepfar has been funded in five-year cycles. In the past the programme has had virtually unanimous support from Republicans and Democrats. But the next funding cycle (from 2023 to 2028) became ensnared in US abortion politics and the fallout contributed to Congress missing the 30 September deadline to allow another five-year funding cycle for the initiative.What’s the link between Pepfar and abortion?US laws already prevent Pepfar (or any state agencies) from paying for abortion services, according to the California-based policy research group, Kaiser Family Foundation (KFF). But in May, a coalition of conservative thinktanks and lawmakers began to make waves with arguments that Joe Biden’s administration has “hijacked” Pepfar to promote abortion instead of treating and preventing HIV.That’s where the risk to Pepfar’s five-year budget emerged – because the Republican lawmakers then refused to sign off on a spending bill for Pepfar if there weren’t stricter rules in place to stop Pepfar funds from overlapping with abortion services in any way.According to Brian Honermann, deputy director of public policy at the US-based Foundation for Aids Research, the allegations that Pepfar has been usurped to push a “radical social agenda” overseas are “baseless” and “stitched together from unrelated policy speeches, documents and assertions about how those apply to Pepfar”.What will happen to Pepfar now?The multibillion-dollar health programme is a permanent part of US law. That means Pepfar funding will continue, but it will lose its favoured position of receiving five years of funding at a time.The failure to reauthorise Pepfar will mean some of its built-in rules will expire, including a guideline that requires 10% of Pepfar money to go to orphans and children in need.Will organisations and governments lose their Pepfar grants?The fund has enough money to pay governments and civil society organisations until September 2024 (about $6.8bn), but a state department spokesperson warns that Pepfar won’t escape unscathed in the long term.Moreover, getting funding for only one year at a time will make it harder for Pepfar to plan ahead and to source crucial HIV tools, such as condoms or medicine, at the best prices. This could ultimately imperil the people that rely on the fund’s support, the spokesperson warned.The symbolic power of a five-year commitment will also be lost, says Honermann. “It shows partner countries that the US is invested for a significant period of time and that Pepfar won’t just disappear.”The threat of a permanent ‘gag rule’Another factor has swirled around Pepfar’s funding drama: some lawmakers have said they’ll only agree to restart the five-year funding regime if the fund is once again subject to the “Mexico City policy”, also called the “gag rule”.The gag rule bans organisations and governments from providing or promoting termination of pregnancy services regardless of whose money they’re using to do it. It was expanded to apply to Pepfar for the first time in 2017. It is only ever enforced when there’s a Republican president in the White House, so is not currently in effect.And while there is no finalised legislation that would make a permanent gag rule a reality (and Honermann argues it would be unlikely to get past the Democrats), the threat of it may already have done some damage.Research conducted by Fòs Feminista, a global alliance that advocates for sexual and reproductive rights, found that the 2022 decision to roll back the national right to an abortion in the US had a contagious impact in a number of countries. In Nigeria, for instance, respondents told Fòs Feminista that local lawmakers were using the change in US abortion laws to push back on a more liberal law in their country. Terminations are legal in Nigeria only if carrying the foetus to term threatens the mother’s life.Recipients of US government funding are often so worried about losing it that they enforce abortion laws more harshly than is necessary. Research shows that confusion about whether the gag rule had been revoked at the start of the Biden administration resulted in the policy – and its harms – being in place for much longer in practice.And the Pepfar wrangling and attendant media coverage has already resulted in mixed messages reaching health advocates in Africa. Some South African activists told the Guardian they were concerned that the news would be calamitous for civil society in the country. Such organisations receive the most Pepfar dollars (44%) in South Africa according to 2020 tracking data. The government gets just under 1.5% of the money.Honermann says that there is an intentional political strategy to keep communication about the changes in restrictions vague. “It’s a way to encourage over-enforcement for fear of falling on the wrong side of this.”He adds: “For now, Pepfar will continue as long as funding is made available. But these political threats to the programme are ultimately playing with the lives of millions of people worldwide who rely on this programme.”What has the reaction been in Africa?Dave Clark is the chief operating officer at the Aurum Institute, a non-profit that works on HIV and tuberculosis (TB) projects in South Africa, Mozambique, Ghana, Lesotho and Eswatini.Aurum is a partner for Pepfar’s Dreams project which works towards an Aids-free future for girls and women aged 10 to 24 by providing HIV services, contraception and violence prevention support for women, adolescents and their sexual partners.One of the major strengths of Pepfar, Clark says, is that it’s a sure-fire source of carefully planned funding for global health in a world that is often more talk than action.He explains: “The debate in America should not throw us off saving lives. Pepfar is what it says on the label: president’s emergency plan for Aids relief. That’s its extraordinary power and legacy.” More

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      Dianne Feinstein should be remembered for her full range of positions: good and bad | Rebecca Solnit

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      Flags are at half mast in San Francisco’s city hall for a woman who was born here and died in Washington DC at the end of a remarkable life. It was inside that building that the most dramatic and pivotal event of Dianne Feinstein’s political career took place, when a murderer made her mayor, the mayor who would become one of the country’s strongest leaders in response to the Aids crisis. That role gave her the visibility to run for the Senate in 1992, and she held onto that seat to her dying day, showing up on Thursday to cast a vote in the budget battle, hours before her death at 90.Senator Feinstein began her political career being ahead of her society and ended it by being behind it. This is not surprising for a public life in politics that stretched through 60 years of dramatic social and political change. But it may be hard to perceive for those who don’t know she was early on a champion for women’s rights – including her own just to participate, at a time when that was groundbreaking – and for rights and recognition for queer people at a time when most politicians would only mention them to demand punishment and ostracization for them.She was one of California’s first two women senators (Barbara Boxer won office in the same 1992 election) and the nation’s first two Jewish women senators, the first female member of the Senate judiciary committee, first woman to chair the Senate rules committee, and in 2009, the first woman to preside over a presidential inauguration.Obama, of course, was that president, and he later opposed her years of effort to expose widespread torture by the Central Intelligence Agency (CIA) during George W Bush’s “global war on terror”. Feinstein, as head of the Senate intelligence committee, fought both presidents, the CIA’s director and various Republicans to release a scathing summary report on that torture. But she also defended the National Security Administration’s surveillance of US citizens.She was often a contradiction and always a patrician, born into wealth and becoming far wealthier through her third marriage in 1980 to the billionaire financier Richard Blum. She was also in her Senate career an important advocate for reproductive rights, environmental protection and gun control. But in recent years, she seemed like a ghost moving among ghosts, acting as though collegiality, bipartisanship and adherence to norms still prevailed in a Senate in which most Republicans had long been ruthless, reckless partisans whose one goal was power.Upon news of her death on Friday, many recalled her patronizingly clueless response to young members of the Sunrise Movement occupying her office in 2019 to press for passage of the Green New Deal. She had remarkable achievements in old-school environmentalism, with legislation that protected millions of acres of the California desert, then did the same for redwood forests and Lake Tahoe. But she too often deferred to business interests – as Mother Jones noted: “She brokered a monumental restoration agreement on the valley’s overstressed San Joaquin River in 2009, but then helped override species protections for fish on that same river in 2016.”First elected to the San Francisco board of supervisors in 1970, she became its first woman president. On the morning of 27 November 1978, the former policeman Dan White, who’d resigned from his seat on the board of supervisors, snuck into San Francisco city hall through a basement window carrying a gun. He demanded the liberal mayor, George Moscone, restore him to his position, and when Moscone declined, White fired several bullets into the progressive, finishing him off execution-style with a bullet to the head, then ran past Feinstein’s open office door as she called to him, and murdered the supervisor Harvey Milk, the country’s first gay elected public official.Feinstein was the first to try to come to Milk’s aid; she reached for his wrist to take his pulse, only to have her finger go into one of the dead man’s bullet wounds. Cleve Jones, Milk’s friend and aide, remembers her sleeve and hand were red with Milk’s blood when he got to city hall later that morning. Cleve, who remains a political activist to this day, told me on Friday: “I have so many conflicting feelings about Dianne Feinstein. We have never been close friends, but we have quite a history and even at those moments when I was the most angry with her for whatever reason, we aways had this bond that we both were there in city hall looking down at Harvey’s body, and that was something that changed both of our lives forever.”The video of a shaken Feinstein telling the press, to audible gasps and cries, that the two officials had been murdered and that the suspect was Dan White, is still riveting. She stepped into the mayor’s seat later that day and won re-election for two full terms. She picked a gay man, Harry Britt, to take Harvey Milk’s seat. Jones recalled: “There was a time when every candidate for public office refused to acknowledge the existence of LGBTQ+ people. There’s no question that Dianne Feinstein was one of the very first political leaders in the country and the world to acknowledge the existence of our community, to seek our vote, and to attempt to represent us on the issues that matter.”He continued: “When Aids started, it unleashed an incredible amount of cruelty. People were celebrating what was happening to us because first it was seen as a gay disease.” The Black community was also hugely impacted, and so “that initial reaction of homophobia compounded by racism led to some really horrible demagoguery”. Feinstein, he says, “rejected all that hatefulness with love and compassion and a belief in science”. Under Feinstein’s leadership, San Francisco led the world in Aids research, treatment and advocacy. Jones told me that watching her decline was sad, because “whether I agreed with her or not on her issues and her class loyalty, she was brilliant, truly brilliant” in her prime.When I moved to San Francisco at age 18 in 1980, Feinstein had been in city government for a decade. I never saw her in person, but she was omnipresent throughout my adult life, first as my mayor, then after a few years out of office my senator. She was a highly recognizable figure, tall and upright, with a helmet of black hair and boxy skirt suits, and she was often mocked locally by constituents far to the left of her. Like so many public figures, Feinstein was full of contradictions, sometimes brave and ahead of her time, sometimes mired in the status quo.But early on she did make waves by her very existence as a woman who entered the political arena at a time when women were unwelcome and largely absent there; later, she made more when she fought the CIA to expose their human rights abuses and took on the gun industry with her campaigns for banning assault rifles and regulating gun access. She deserves to be remembered for the full range of her achievements and positions, good and bad.
      Rebecca Solnit is a Guardian US columnist. She is the author of Orwell’s Roses and co-editor with Thelma Young Lutunatabua of the climate anthology Not Too Late: Changing the Climate Story from Despair to Possibility More

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      The abortion rights movement can learn from the Aids activism of the 80s and 90s | Moira Donegan

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      The abortion rights movement can learn from the Aids activism of the 80s and 90sMoira DoneganAct Up employed a multiplicity of tactics and responses while maintaining a laser-focused singleness of purpose It was already chaos, and now, it was going to get worse. The US supreme court’s decision wasn’t exactly a surprise – everyone knew it was coming – but the rage in the room felt palpable. The language of the opinion had been taunting and cruel; the punishment from the court felt vindictive, personal. People were already dying for lack of access to healthcare; the ruling would push people in need even further to the margins. Now, the most vulnerable faced criminalization, harassment and even death, and for what? For the conservative Christian values that none of them had voted for? For a regressive, punitive, and cruel vision of gender and sexuality that most of the world had long since left behind?The ruling was Bowers v Hardwick, and the year was 1987. The supreme court, in a virulently homophobic opinion, had upheld a Georgia law criminalizing gay sex between consenting adults. At the time, the Aids crisis was gripping gay America. Out of bigotry and indifference, both the federal government and the pharmaceutical sector were dragging their feet. Meanwhile, thousands of people, mostly gay men and IV drug users, were dying slow, painful, premature deaths, at the margins of a society that hated them and feared their disease.The moral stakes couldn’t have been more clear: a backwards and oppressive understanding of gender was creating needless suffering and death. It wasn’t the birth of Act Up, the radical grassroots activist group that confronted the Aids crisis in America, but it was the moment when Act Up was energized into the powerful force it would become. At the group’s regular Monday night meetings at New York’s Lesbian and Gay Center, the crowd swelled with outraged queers ready to be organized.The reproductive rights movement now faces a similar moment of rage and revival. Since the Dobbs opinion reversed Roe v Wade and eliminated the constitutional right to an abortion, there has been an outpouring of pro-choice sentiment from previously unorganized or apolitical citizens. Meanwhile, an onslaught of horror stories is pouring out from conservative states: miscarrying patients going into septic shock before they can be treated; women forced to carry dead or doomed fetuses for weeks; little girls, raped and impregnated by men they thought they could trust, fleeing their states to get the abortions that will allow them to reclaim what’s left of their childhoods. This is just the beginning: there will be more of these stories, many more, and they will get worse.Like the gay community in 1987, American women are now faced with a moment of profound terror, anger, and grief whose full extent is yet to be seen. A slogan advanced in recent years by the pro-abortion group We Testify attempts to destigmatize the procedure: everyone loves someone who’s had an abortion. Soon, everyone will know someone who has needed an abortion, and struggled to get it.Moments of feminist rage aren’t uncommon in American politics, but the ability to harness women’s anger for political ends has been a trickier feat, especially in recent years. The Women’s March, which followed Donald Trump’s election, drew in giant numbers for street protests, but was unable to harness its support toward a specific agenda. The organization was hobbled by infighting and lack of direction. Later, the #MeToo movement was able to generate public conversation and remove a number of high-profile abusers from positions of power. But #MeToo was not able to translate its moral authority into a political platform.Act Up offers a different model, one with a proven record of success. Like feminists and abortion rights supporters now, Act Up was composed of people of varying backgrounds, commitments, and ideologies. They had different priorities, skills, and ideas; different perspectives and styles. But they all shared the same goal: to combat the Aids crisis, and to improve the lives of people with Aids.The writer and teacher Sarah Schulman, an Act Up veteran, attributes the group’s success to “a strategy of difference facilitating simultaneity of response”. In other words, a lot of different kinds of people were using different tactics, all in pursuit of the same things. Under this broad but well-defined agenda, the group was able to transform its varied constituency into an asset – not a liability.Over the five years that it was most active and influential, 1987-1992, the group was able to successfully lobby to lower drug prices, get more people included in trials, extend Aids benefits to women, and cut red tape to get more treatments to market. Their loud, aggressive, and irreverent public demonstrations at the FDA building and in the offices of pharmaceutical executives were carefully targeted and publicized, meant to garner publicity and also to be as uncomfortable and inconvenient as possible to the powerful people who were standing in their way. Now, the mainstream media scolds protesters for holding demure vigils outside the home of Brett Kavanaugh in Chevy Chase, Maryland. Back then, Act Up went down to DC to protest outside a politician’s home, too. They found out the address of the rightwing, anti-gay North Carolina senator Jesse Helms, and with the news cameras rolling, put a giant condom over his house.Maybe one of the great lessons of Act Up is this willingness to embrace irreverence and joy, something the reproductive rights movement, to their great credit, have also embraced. But another virtue is that the group employed a multiplicity of tactics and responses while maintaining a singleness of purpose.Feminism, as a movement, has long had a problem of unsustainably expanding responsibilities. Because women exist in all walks of life, any social problem can be cast as a feminist problem. But no movement can take on responsibility for every injustice in the world. Like Act Up, the reproductive rights movement would be wise to assign itself an expansive understanding of a narrow remit.Act Up aimed to combat the Aids crisis and improve the lives of people with Aids, a purview that enabled different factions within the group to take on issues of drug access, housing discrimination, sex education, and the power of the Catholic church. Likewise, the reproductive rights movement would be wise to dedicate itself only to the emergency at hand: abortion access, and the lives of people who need abortions. It is there that they can do the most good for those affected, and it is where they can reshape, as Act Up did, both the public debate and the facts on the ground.Much of this is already happening. In the years that the right has been ascendant and abortion supporters have been on the defensive, large, national non-profit advocacy groups have mostly been on the back foot. But in the places they have vacated, a vast network of small but mighty local organizations, and abortion funds, have stepped in to help those seeking abortions with material needs. These groups represent an essential intervention in material service provision. They can also form the foundation for what feminism needs now: an organized political movement.
      Moira Donegan is a Guardian US columnist
      TopicsAbortionOpinionUS politicsAids and HIVLGBTQ+ rightsHealthcommentReuse this content More

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      How Trump success in ending Obamacare will kill Fauci plan to conquer HIV

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      In his State of the Union address in February 2019, Donald Trump vowed to end the HIV epidemic by 2030.
      But if Trump has his way and the supreme court strikes down the Affordable Care Act (ACA), the resulting seismic disruption to the healthcare system would end that dream.
      Democrats have expressed grave concern that if Amy Coney Barrett is seated on the supreme court, the conservative jurist could cast a decisive vote to destroy the ACA in the California v Texas case scheduled for oral argument starting 10 November. The Senate judiciary committee will vote on Barrett’s nomination on Thursday. A full Senate vote is expected on Monday.
      The brainchild of Dr Anthony Fauci and other top brass at the Department of Health and Human Services, the ambitious Ending the HIV Epidemic: A Plan for America has received for its debut year $267m in new federal spending, largely targeted at HIV transmission hotspots across the US. More