Three mistakes that matter more than the State Department's messed-up Africa map.

And the 2026 To End a Plague: Again Award for Handsomest Man in the World.

So that happened.

Alt text: An illustration of a map. The shape of the landmass is the shape of the African continent. There are six countries labeled on the map. None of them are correct. This is a recreation of the map shown at an AIDS2026 pre-conference by the US government, except that THAT map didn’t say “Wish you were here! xoxo State” and also did not have a cute eagle seal in the upper left. That map also didn’t label the country that is, in this map, called Cameroon. It came close. Then quit. This incredible drawing is by Hailey Morey (check her out on @hmmakesart on Instagram) and if you would like your very own copy on a magnet (1) become a paid subscriber and (2) order one using the same email address you used for your subscription. There will never be a paywall on this Substack. Everything I know and have validated, I eventually share. This takes time. I’d do it anyway but I can share faster and more frequently if I can pay myself for my time and give Hailey a cut for her brilliance. That’s just how it works. Thank you for subscribing if you can and upgrading to paid if that is possible.

A little over a week ago, I posted a photo—sent by an audience member—of a slide presented by the senior leader of the Bureau of Global Health Security and Diplomacy, of an utterly mis-labeled, bananapants¹ African map. And for a few days, after major media picked up the story, it was the screenshot heard ‘round the world.

It’s a story that could easily not have happened.

Other write-ups of the session left out the map. I wouldn’t have posted if the presenter had acknowledged the mishap, apologized or made any other type of reference to the mis-labeled image. I verified from several people in the room² that neither the presenter, nor anyone else from the US government said anything about it.³

If any of the US government reps—several of whom I know have the contours and country borders of the continent engrained in their hearts and mind—had said anything at all, I wouldn’t have covered the new US map of Africa at all.

Everyone makes mistakes. At our best, we own them as quickly and fully as possible. But at our worst, we can’t or won’t see them. We make giant blunders and we pretend they didn’t happen or we don’t even realize that we’ve done colossal harm.

That’s what the United States government is doing with its no-brakes, no-transparency, no-data approach to foreign aid for global health. It’s making one mistake after another that it either doesn’t see or doesn’t care to acknowledge. This Substack, for those who’ve recently joined, is primarily devoted to keeping the receipts of this unfolding, studiedly opaque and unaccountable process.

I am not here to shame individuals for human errors. I am here to point out catastrophic blunders by the government that collects my tax dollars that will cause harm and suffering in places I love and can label—capital cities and all—on a map. Here are three mistakes that matter more than the map from AIDS 2026.

1) Rubbishing a report of “near universal” disruption of HIV services—instead of taking responsibility and action

Elise Lankiewicz (Senior Policy Associate, amfAR) presented the results of a survey of 166 PEPFAR “implementing partners” (IPs) from 46 countries—approximately 23 percent of the PEPFAR IP universe.⁴ Lankiewicz summarized the results as “near universal” disruption, “even among partners whose services were nominally protected,” meaning those activities for which the US government issued a waiver after the foreign aid freeze in 2025.

Here is what “near universal” looks like:

Alt text: A slide titled “Damage across the system” that has dark blue, lighter blue and gray bars. The gray bars are ‘any disruption.’ The lighter blue bars are ‘reduced.’ And the darker blue bar is ‘permanently stopped.’ The left hand text says “77% of respondents reported a delayed or terminated award. I describe the types of services in the body of the text. There is a thumbnail photo of Elise giving the presentation in the upper left. I was in the room while she spoke and was, frankly, surprised by the force of the emotion (relief, release, recognition) I felt in seeing credible, rigorously-collected evidence for what is known to be true and yet steadfastly denied by the US government.

According to survey respondents, every single activity area that matters for effective HIV programs that keep people healthy and flourishing was affected: testing, treatment, prevention, community-based services. The worst impacts happened to the most vulnerable groups: key populations like gay men and transgender women who are criminalized, stigmatized and at enormous risk of HIV.

Instead of responding to this survey with concern, grace, curiosity or—imagine it—apology, the US State Department said, to the New York Times, “We have not verified this specific report but we can categorically say that its methodology is flawed.”⁵

I’m sorry (see how easy it is to say that?). Could you run that by me one more time?

The US State Department got a report of widespread, lethal harm among its own programs. It didn’t look into it. And yet it knows the report is wrong. You actually have to pick one: (i) Not verifying or (ii) Confidently trashing. You can’t do both. Even if you think you can.

2) Ignoring evidence that children with HIV are dying painful preventable deaths because of US government funding transitions.

Ramona Godbole (Senior Manager at the Clinton Health Access Initiative (CHAI) and a Researcher at the Heidelberg Institute of Global Health) presented an elegant analysis of PEPFAR’s own data on the number of children (<15 years) living with HIV supported on treatment that suggests young people—fifty percent of whom will die before their second birthdays without antiretroviral—are losing access to care.

When the US government shared the Measly Quarter of program performance data (July-September 2025), the official fact sheet crowed that the number of children living with HIV was declining because of continued program impact.⁶ And under any circumstances other than a year of complete, reckless disruption, it could have been.

Prevention of vertical transmission (from parent to child during pregnancy, labor and breastfeeding) has been highly effective. Fewer children are being born with HIV, and children living with the virus are enjoying long healthy lives—aging out of the “child” age cohort and into adulthood. A reduction in the number of kids living with HIV supported by PEPFAR could be a sign that this cohort is contracting.

Godbole explained this before she compared the absolute number of CLHIV supported by PEPFAR at the end of FY2025 compared to FY2024: 77,163 fewer CLHIV between one year and the next.

Alt text: A slide with a lotta blue dots. One set of blue dots has the number 542,236 above it, and the other has the number 465,073 next to it. Those are the absolute numbers of PEPFAR-supported children living with HIV according to the US government’s own data from FY2024 and FY2025. The text on the lefthand says that these numbers work out to a 14.2% decline over 12 months. There is a thumbnail on the right hand side of the speaker, Ramona Godbole. This is a screenshot from the IAS replay that’s available to people who came to the conference. But I was in the room for all of the presentations described in this stack.

She then compared the rate of contraction in the size of the PEPFAR-supported CLHIV cohort over the past several years and showed clearly that the FY2024-FY2025 decline, which occurred over the course of the period in which USAID was destroyed, services were halted and then restarted with more limited remits, and community programs were decimated, was bigger than any previous year on year decline.

Alt text: A second slide from Ramona Godbole’s presentation showing the percentage decline from one year to the next in the number of children with HIV supported by PEPFAR. In period’s without catastrophic disruption, the largest decline was 8.5 percent. Having sat in a room with nurses, counselors and children living with HIV talking about the approach to rationing food packages for these children and worrying about who will support them on their clinic visits now that the salaries for their counselors are gone, it is not plausible to me that this accelerated decrease reflects a banner year for PEPFAR-funded programs.

When I say this was staring the US government in the face—I mean it literally. A high-ranking GHSD staffer from the Office of Health Programs was in the room for Godbole’s presentation. And said nothing.

3) Concealing the details of future America First Global Health Strategy plans and investments from the people in the countries with the clearest picture of what’s going on.

In a must-view session called, “The cost of cuts: Human and systems impacts on the HIV response,” presenters described the impacts of funding cuts by the US government and as result of “reprioritization” of Global Fund grant cycle 7 resources in Kenya, Mozambique, Nepal and Nigeria. Each of the presentations was gut wrenching and specific. Together they constitute evidence of what may someday be correctly evaluated as a crime against humanity. Immediate drops in testing, antiretroviral treatment initiation, access to supportive services and care. How immediate? How catastrophic? Presenter Glenda Baguso, a California-based nurse and public health expert working with trans communities said it plainly: “Decades to build, months to unravel.”

Alt text: Four people sitting on a stage in front of a green background with aids2026.org and iasociety.org in white. Two of them have snazzy sneakers on. From left, those are session co-chairs Adele Benzaken and Jon Cohen, then there is Joram Sunguti Luke (Pathfinder, Kenya) who presented truly sobering modeling analysis drawing on a range of studies of projected impacts of prolonged and intermittent funding cuts, and Alice Pedro Mageia de Abreu (Maputo Municipal Council, Health and Quality of Life, Maputo City, Mozambique), who showed sharp drops in HIV tests, positive diagnoses and antiretroviral initiations in Maputo City in the months immediately after the funding freeze and stop work order, with some recovery thereafter.

Kenya, Mozambique and Nigeria all have signed Memoranda of Understanding with the US government under the America First Global Health Strategy. They have, or will soon have, implementation plans for work in FY2027 (which starts on October 1 of this calendar year.) The specifics of these plans will influence whether the impacts to date persist and worsen—or whether remediation or stabilization actually occurs. During the question and answer period, I asked the speakers from these countries if they’d seen the MoUs or the implementation plans, or if they had knowledge of what was going to happen next in terms of US funding. Not one of them had this kind of information. When the experts whose abstracts on in-country impacts rose to the top of a large pool in a highly competitive, vetted process do not know what the future holds, something is terribly wrong that a better map key just can’t fix.

Alt text: A slide with the words “Decades to Build. Months to Unravel. Protecting Nepal’s progress towards ending HIV requires sustained investment in trusted, community-based prevention services.” Preach. That’s from Glenda Baguso of University of California, San Francisco, Institute of Health & Aging, and the San Francisco Department of Public Health, Center for Public Health Research. Pictured is Sean Nurmsoo, Clinical Fellow at Brigham and Women’s Hospital, Dana-Farber Cancer Institute, and Harvard Medical School in Boston, United States, who didn’t miss a beat or blame a staffer when his slide presentation failed to load, and explained a truly intriguing analysis of the Global Fund supply chain “on time” delivery performance of ART and TB that I plan to come back to in a future post.

Those are three examples of mistakes that it is upon the US government leadership to correct. Not to fob off on staffers who are not responsible for or in control of whether their bosses acknowledge errors gracefully. Not to dismiss without interrogating. Not to persist in because it is hard to admit you were wrong.

Usually the subscribe button is the end of the Substack. But if you’re just now arriving, or if you’ve been here for a minute and just haven’t known how to ask: those lines above the subscribe buttons are song lyrics.

Every Stack has a song. It’s usually pertinent in some way if you look at the lyrics. Sometimes there’s a guest DJ. I don’t tell who it is. I do make playlists. There is one so far. The next one drops August 8. They all live here.

This stack’s song, “What Have I Done to Deserve This” by Pet Shop Boys goes out to the one and only Ben Plumley, a dear friend, mentor, collaborator and titan of the HIV response who is a huge fan of the Boys and who received an award at IAS for his lifetime of work in the field this week. Every day of my friendship with Ben and his husband Erik I wonder “what have I done to deserve this” abundance of humor, wisdom, clear-sidedness, red wine, potato chips, streaming television and canine brilliance. I love you so much.

Alt text: The most handsome man in the world.

1. Hi and welcome to the footnotes. Or back to the footnotes, if you’ve been around this here Substack before. (I’ve had a wee bump in subscribers since the United States landlocked Nigeria and all the rest, so I’ll be doing a house tour as we go along.) To End a Plague: Again Footnotes are for: sourcing and side quests. I’ll tell you what I know and where I found it, explain terms and give more detailed background than many people would want. I will also explore really crucial questions like: What would Marco Rubio look like as a unicorn? Does lopsided take a hyphen? What would a Chemonics public affairs spokesperson’s official statement sound like if re-written by AI in the style of James Joyce? (Yes, that last one is real and that’s the only time I’ve used AI to write anything. I do use AI to proofread even though I have a coupla folks who are quick to tell me when I’ve mid-identified a word. I also sometimes use AI to look at maps it might recognize and to scan hundreds of pages of documents. If you ever have a question, just ask.) What is this footnote for Emily? Good question: bananapants is a term of art in this Substack. It is nicer than and means the same thing as “batshit crazy” (mean to bats, Wuhan adjacent), or bonkers, or loony, or whackattack. If you’d like to become a member of Bananapants Nation, I will send you your very own trio stickers. Just (1) become a paid subscriber and (2) order here.

2. I wasn’t physically in Rio for the presentation, as some stories reported. This was explicit and obvious in the Substack I wrote about—which was based on verified slide images and audio recording. It’s important to proofread your slides and to read source material all the way til the end.

3. It’s also important to look at the audience every once in a while and to ask yourself: Is there some reason, other than my scintillating speech, sharp style and shiny slides that the room looks like this?

4. In the context of the US government HIV program, an “implementing partner” is an organization that gets money to carry out activities. Often there are large awards made to IPs who are the “primes” that then make onward sub grants to other groups. A prime can be from anywhere, including a “local” IP, based in and led by people from the country where the program is being operated. This survey only talked to primes and, compared to the overall PEPFAR “universe” had a slightly higher proportion of local partners. This matters because the local groups are the ones that will always be in a position to meet community needs; they are the frontlines and cornerstones of continuity.

5. https://www.nytimes.com/2026/07/21/health/hiv-trump-cuts-pepfar.html

6. https://www.state.gov/releases/office-of-the-spokesperson/2026/04/pepfar-data-release-2/