Hustling PEPFAR: Making Global Public Health Work in Nairobi

In 2003, amidst a groundswell of activism on behalf of children living with HIV, the United States initiated the President’s Emergency Plan for AIDS Relief (PEPFAR). Suddenly, children who were born with HIV in PEPFAR-supported countries had access to antiretroviral medication. Those children are now considered the first generation of people born with HIV to live into adulthood. Drawing on ethnographic fieldwork and a twelve-year-relationship with Mwana Mwema, a network of faith-based pediatric HIV clinics across Nairobi that were supported by PEPFAR and the United States Agency for International Development (USAID) before their abrupt closure in 2024, I explore the ways PEPFAR and USAID policy became imbedded in the lives of some of these young adults. Analyzing the fragile social, financial, and spiritual ecosystems instituted through global health policy, I illuminate how young adults and practitioners widened the impact of PEPFAR and made the initiative work despite its contingent nature.