Miriam Rabkin
@miriam2024.bsky.social
Physician, feminist, North Carolinian. Global Health consultant working on HIV and health systems. Just lurking/reposting for now…
Really, @nytimes.com, you think that “thousands” is a good way to describe turnout at the 2,700 #NoKings events that took place in all 50 states yesterday? @indivisible.org
October 19, 2025 at 10:47 AM
Really, @nytimes.com, you think that “thousands” is a good way to describe turnout at the 2,700 #NoKings events that took place in all 50 states yesterday? @indivisible.org
Dinosaurs ✅, frogs ✅, bubbles ✅, music ✅, righteous nonviolent outrage at the attacks on our democracy ✅ #NoKings #Carrboro @indivisibleocnc.bsky.social #Indivisible
October 18, 2025 at 10:04 PM
Dinosaurs ✅, frogs ✅, bubbles ✅, music ✅, righteous nonviolent outrage at the attacks on our democracy ✅ #NoKings #Carrboro @indivisibleocnc.bsky.social #Indivisible
And here's a "Disinformation Bingo" card you can use while watching ...
September 4, 2025 at 1:07 AM
And here's a "Disinformation Bingo" card you can use while watching ...
And here is the French fry squirrel 🐿️ 🍟
August 29, 2025 at 9:41 PM
And here is the French fry squirrel 🐿️ 🍟
Ok, I called Valerie Foushee and Thom Tillis to urge them to help remove RFK Jr. If I have to call Ted Budd in order to see the pizza squirrel, I’ll do it, but otherwise, I’ve stopped even trying with that guy.
August 29, 2025 at 6:46 PM
Ok, I called Valerie Foushee and Thom Tillis to urge them to help remove RFK Jr. If I have to call Ted Budd in order to see the pizza squirrel, I’ll do it, but otherwise, I’ve stopped even trying with that guy.
Can’t resist this xkcd classic imgs.xkcd.com/comics/wrong...
August 26, 2025 at 11:20 AM
Can’t resist this xkcd classic imgs.xkcd.com/comics/wrong...
The 2025 #UNAIDS annual update predicts that if the current funding cuts continue, there could be an additional 6 million HIV infections and an additional 4 million AIDS-related deaths by 2029 #HIV www.unaids.org/sites/defaul...
July 11, 2025 at 5:54 PM
The 2025 #UNAIDS annual update predicts that if the current funding cuts continue, there could be an additional 6 million HIV infections and an additional 4 million AIDS-related deaths by 2029 #HIV www.unaids.org/sites/defaul...
March 19, 2025 at 9:33 AM
Lors d'un webinaire organisé aujourd'hui, Dr Irenio Gaspar, du ministère de la santé du Mozambique, fait état d'une baisse marquée de la PrEP à la suite de l'arrêt du #PEPFAR. Un enregistrement du webinaire sera bientôt disponible sur cquin.icap.columbia.edu.
March 13, 2025 at 12:52 PM
Lors d'un webinaire organisé aujourd'hui, Dr Irenio Gaspar, du ministère de la santé du Mozambique, fait état d'une baisse marquée de la PrEP à la suite de l'arrêt du #PEPFAR. Un enregistrement du webinaire sera bientôt disponible sur cquin.icap.columbia.edu.
Dr. Irenio Gaspar from the #Mozambique Ministry of Health reports that most #HIV testing in the country has stopped, due to loss of #PEPFAR support. HIV prevention (PrEP) & treatment initiation have also plummeted. A recording of the webinar will be available soon at cquin.icap.columbia.edu
March 13, 2025 at 12:38 PM
Dr. Irenio Gaspar from the #Mozambique Ministry of Health reports that most #HIV testing in the country has stopped, due to loss of #PEPFAR support. HIV prevention (PrEP) & treatment initiation have also plummeted. A recording of the webinar will be available soon at cquin.icap.columbia.edu
Ministries of Health and recipients of #HIV care and treatment in Africa will discuss the interruption of #PEPFAR funded services on Feb 18 - register for the webinar here: columbiacuimc.zoom.us/webinar/regi...
![A webinar flier: "Sustainability, Resilience and Emergency Response: How are African Countries Responding to Interruptions in HIV Funding?" Tuesday February 18, 8am EST / 2pm WAT / 3pm SAST / 4pm EAT. There is a registration link (also in the post above) and a note that the webinar will be 90 mins, and simultaneous translation will be available in English and French. Description includes: "This webinar will explore emergency responses to address the interruptions in HIV funding for sub-Saharan African countries. The focus will be on maintaining core HIV services across prevention, care, and treatment, including rapid testing, ART initiation, PrEP [pre-exposure prophylaxis], DSD [differentiated service delivery], and person-centered services. The webinar will also cover prioritizing service integrity through HIV program monitoring and quality assurance, as well as strategies to enhance recipient of care engagement, ensuring that their voices and needs are central to the design and implementation of these emergency responses."](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:qd7hkt5zfohvhjzvaejn73nl/bafkreiettkgafp7rwnzivz6433gddjo4cc4nxgtrt4l7fsssnfncswaddu@jpeg)
February 11, 2025 at 2:44 PM
Ministries of Health and recipients of #HIV care and treatment in Africa will discuss the interruption of #PEPFAR funded services on Feb 18 - register for the webinar here: columbiacuimc.zoom.us/webinar/regi...
Malawi's Ministry of Health has issued a formal contingency plan in response to the "temporary suspension of support from #PEPFAR", triaging #HIV services and noting that routine viral load testing, early infant diagnosis, and pre-exposure prophylaxis (PrEP) may need to be reduced or discontinued.
![03rd February 2025
From: THE SECRETARY FOR HEALTH, MINISTRY OF HEALTH,
P.O. BOX 30377, LILONGWE 3
To: DISTRICT COMMISSIONERS
Attention: Directors of Health Services, DIRECTOR GENERAL, ALL CENTRAL HOSPITALS
RE: PROVISION OF UNINTERRUPTED HIV SERVICES ACROSS ALL HEALTHFACILITIES
In reference to the circular dated 28th January 2025 and issued with the same subject as above, the Ministry of Health wishes to communicate the following measures as part of the contingency plan to respond to the temporary suspension of support by PEPFAR and its implementing partners.
The ministry instructs that these measures be implemented without delay. The measures are as follows:
• Redeployment of trained Ministry of Health (MOH) staff for HIV testing, ART dispensing, and targeted viral load monitoring to fill gaps left by PEPFAR-funded personnel.
• Optimize 6-month ART dispensation to reduce clinic visits and ease the burden on health facilities.
• Train and utilise community health workers (Health Surveillance Assistants and community midwives' assistants) for ART refills targeting stable and eligible clients.
• Train and utilise community structures like Community ART Groups (CAGS} in the high burden districts in the Southern region for ART refills targeting stable and eligible clients.
• Stock redistribution in case of over-stock/understock to avert expiries and stock outs.
• Facility-level task shifting, leveraging Health Surveillance Assistants (HSAs) and hospital attendants to assume responsibilities previously managed by PEPFAR-supported staff.
• Leverage private sector and CHAM/IHAM facilities to absorb ART patients (from high-volume ART clinics) if necessary.
[continued on p2]](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:qd7hkt5zfohvhjzvaejn73nl/bafkreiddnsfbtv5hrk74yllont37bdzl2myc3owpmpkcxyrpwjmnazcmue@jpeg)
![• Strengthen telemedicine and digital health platforms for ART patient follow-up and remote clinical consultations.
• Expand the role of Community Health Workers for patient follow-up, defaulter tracing, and condom distribution.
• Nationwide site-level quarterly data validation and supervision of HIV services shall now be conducted bi-annually by district teams with technical and logistical support from the central government.
Further to that, ALL health facilities offering HIV care must adopt the following measures:
Category A: The following services are considered as lifesaving
(immediate priority) and therefore must be continued at all costs.
• ART Initiation and Continuation (Facility-based).
• HIV Rapid Testing for:
o Pregnant women, sick children, and HIV-exposed infants (at 12 and 24 months).
o In-patients, STI patients, TB clients, suspected HIV cases, and blood donors.
• Targeted HIV Viral Load Testing (for patients suspected of treatment failure).
• TB Screening for ART patients.
• Facility-Based Condom Distribution.
• ART Dispensation (Optimizing 6-month ARV supply for stable patients).
• Infant HIV Prophylaxis (Nevirapine [NVP], 2P [Zidovudine/Lamivudine/Nevirapine], Cotrimoxazole [CPT]}.
• Electronic Medical Records System (EMRSJ Support (Data security, ART patient registration, and facility-based data capturing}.
Category B: The following services are considered as essential (high priority) and therefore must be continued but requiring adjustments.
[continued on p 3]](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:qd7hkt5zfohvhjzvaejn73nl/bafkreiddhekkap5xnpkljr2vbey56tekfcakz2hfe36kuh2io7a5gp6nkq@jpeg)
February 4, 2025 at 6:27 PM
On first read, the #PEPFAR waiver does not appear to include HIV prevention services for anyone other than pregnant women and their infants ...
![Memo page 1/3 reads: "SENSITIVE BUT UNCLASSIFIED FEBRUARY 1, 2025
Info Memo for the PEPFAR Implementing Agencies and PEPFAR Country Coordinators
FROM: GHSD – Jeff Graham, Senior Bureau Official
SUBJECT: Implementation of Limited Waiver to Pause of U.S. Foreign Assistance for Life-Saving HIV Service Provision
The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) has been granted a limited waiver to implement urgent life-saving HIV treatment services in alignment with the Secretary of State’s January 28 memo “Emergency Humanitarian Waiver to Foreign Assistance Pause” and subsequent January 30 confirmation to GHSD from the Director of Foreign Assistance (F). Per the terms of this limited waiver, only the following activities may be resumed during the 90-day pause or until superseded by new guidance:
1. Life-saving HIV care and treatment services, inclusive of HIV testing and counseling, prevention and treatment of opportunistic infections including TB, laboratory services, and procurement and supply chain for commodities/medicines.
2. Prevention of mother-to-child transmission services, inclusive of commodities/test kits, medicines and PrEP for pregnant and breastfeeding women.
3. Reasonable implementing agency and implementing partner administrative costs strictly necessary to deliver and provide oversight of this assistance, including related country-based data activities and portions of PEPFAR’s central data platform used for clinical monitoring and program management.
PEPFAR implementing agencies should continue to pause foreign assistance, as stipulated in 25 STATE 6828, for all other activities not covered by the [continued on page 2]](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:qd7hkt5zfohvhjzvaejn73nl/bafkreib4z72hwx4wjke5tqkwtrfha7ifxu4457a6x75ugysspxmocm2z7m@jpeg)
![Page 2/3 reads: "...Secretary’s waiver until completion of the foreign assistance review or further guidance. This waiver does not apply to activities that involve abortions, family planning, conferences, administrative costs other than those covered above, gender or DEI ideology programs, transgender surgeries, or other non-life saving assistance. Any other activities not specifically mentioned in this guidance may not be resumed without express approval.
Upon receipt of this guidance, all PEPFAR agencies may resume activities covered by the limited waiver. The following implementation actions may only be undertaken as necessary to carry out this guidance:
• Disbursements and incremental obligations on existing awards.
• New obligations only in cases where pre-planned award transitions previously existed for the activities listed above or where awards that have been paused cannot be restarted.
Limited Waiver Accountability Plan:
• The GHSD Senior Bureau Official will review and certify to the State Department’s Comptroller and Global Financial Services (CGFS) that any resumption of work, obligation, or disbursement of any PEPFAR funds held at the State Department is consistent with the activities listed above.
• For resumption of work, obligation, or disbursement at the PEPFAR Implementing Agencies, GHSD/PEPFAR is directing PEPFAR Implementing Agency Lead Deputy Principals to execute a similar certification process that aligns with their agency policies and comprehensively report that information to GHSD every 30 days, with the first report due on February 28, 2025.
GHSD/PEPFAR will stand up an interagency team to provide ongoing guidance. In the interim, please send any questions to your agency DPs.
Thank you for your immediate attention to implementing this guidance in strict accordance with the terms of the limited waiver. We will update you further if we receive additional guidance from Department of State leadership. [continued on p 3]](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:qd7hkt5zfohvhjzvaejn73nl/bafkreif37nbdzxppefc5q4q6t7aqeqdarhodfoch64z5xjzdtbee2rugaa@jpeg)
![Tab 1: Additional details on approved activities under the limited waiver
For purposes of this limited waiver, life-saving humanitarian assistance applies only to:
•Delivery of life-saving HIV care and treatment services through support for health workers (doctors, nurses, and other clinical and community health workers, etc.) delivering or monitoring HIV care and treatment to ensure continuity of service provision. These workers deliver care at hospitals, primary healthcare clinics, faith-based clinics, and community settings.
Provision of HIV testing for adults and children in community and facility settings.
Provision of HIV drugs and support to prevent treatment interruptions for adults and children in community and facility settings.
Provision of care for advanced HIV disease, including CD4 testing (immune function test), prevention and treatment of opportunistic infections, and HIV treatment adherence support.
Provision of HIV viral load testing, which allows patient monitoring to ensure that HIV drug treatments are effective.
Provision of tuberculosis preventive therapy (TPT) and Tuberculosis Treatment, as TB is the largest killer of people living with HIV.
• Support for transportation, storage, distribution, and management of HIV care and treatment commodity supply chain to ensure timely provision of medications and tests to patients
• Procurement of HIV medicines and other commodities required for provision of HIV care and treatment services to prevent stockouts in national HIV programs (e.g., HIV drugs, HIV test kits, early infant HIV tests, viral load tests and lab equipment for clinical monitoring, TB prevention and treatment drugs, opportunistic infection medicines for advanced HIV disease).
• Prevention of Mother-to-Child Transmission of HIV, which consists of testing and re-testing pregnant and breastfeeding women, providing HIV prevention services for [pregnant] women who are HIV negative including Pre-exposure Prophylaxis (PrEP) and HIV …](https://cdn.bsky.app/img/feed_thumbnail/plain/did:plc:qd7hkt5zfohvhjzvaejn73nl/bafkreibkhqybc3wco3pdsgunlojqhjyz7yt4mq4j7bms54oxaduym6magq@jpeg)
February 1, 2025 at 10:39 PM
On first read, the #PEPFAR waiver does not appear to include HIV prevention services for anyone other than pregnant women and their infants ...
The latest PEPFAR Global Results report from 12/2024 projects that without PEPFAR, AIDS-related deaths in 12 partner countries will increase by 400% and the number of AIDS orphans will ~ double: 2021-2025.state.gov/pepfar-lates...
January 31, 2025 at 6:22 PM
The latest PEPFAR Global Results report from 12/2024 projects that without PEPFAR, AIDS-related deaths in 12 partner countries will increase by 400% and the number of AIDS orphans will ~ double: 2021-2025.state.gov/pepfar-lates...