This story was supported by the Pulitzer Center and the Fund for Investigative Journalism.
asserted
story → support → Journalism
When it opened in early 2024, Engage Men’s Health Clinic served as a free, one-stop shop for sexual health, gender-affirming medical care, and HIV prevention, testing, and treatment.
asserted
Clinic → open → health
Located within a short distance of seven universities, it was a place where many college students came before “they’d even had sex for the first time,” a former worker told The Intercept.
asserted
worker → locate → Intercept
This made Engage a “high-impact” clinic for distribution of the HIV prevention drug PrEP.
asserted
Engage → make → drug
The building, on a tree-lined stretch of Reserve Street in Johannesburg, was adorned with the logo for the President’s Plan For AIDS Relief, or PEPFAR; a rainbow-colored mural of Simon Tseko Nkoli, the gay anti-apartheid activist who helped start one of Africa’s first Pride celebrations and who died of AIDS in 1998; and a sign for USAID saying the site was a gift “from the American people.”
asserted
site → line → people
Today, it would be very hard to get help here, despite the welcoming-but-outdated signage.
asserted
it → get → signage
The clinic, once staffed full-time by professionals, closed abruptly during the first hours of the second Trump administration.
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clinic → staff → administration
Its replacement, an unrelated volunteer clinic called USpace, is open a mere four hours a week.
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replacement → call → ?
They can do HIV tests here.
asserted
They → do → tests
But they have no HIV treatment, HIV prevention, or gender-affirming medication to distribute.
asserted
they → have → treatment
South Africans account for about a fifth of the 41 million people living with HIV around the world.
asserted
Africans → account → world
Out of a population of nearly 64 million, some 8 million people in South Africa are living with HIV, which is roughly 1 in 8.
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which → live → 8
Managing their healthcare is a matter of international concern and requires global coordination and an immense local network.
asserted
Managing → manage → coordination
In a nation with such high rates of HIV, public health workers can’t just wait for people to walk into clinics; they must proactively go to them.
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they → wait → them
Yet over the last year and a half, this crucial work has been stymied.
asserted
work → stymie → year
By Jacqueline Pienaar’s count, HIV prevention groups have lost track of approximately 20,000 people with HIV in the Johannesburg and Pretoria region alone since U.S. President Donald Trump came back to the White House.
asserted
Trump → lose → House
“It used to be if someone didn’t show up to get their medication, you’d go to them,” said Pienaar, a principal investigator and global health specialist at the Aurum Institute, an NGO that offers medical care and contact tracing for the region’s massive HIV-positive population.
asserted
that → use → population
For years, the U.S. Centers for Disease Control and Prevention funded her work.
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Centers → fund → work
If they are unaccounted for and unmedicated, their viral loads will spike, all but assuring large transmission increases in a country that is already home to 20 percent of the world’s HIV-positive population.
asserted
that → spike → population
With U.S. funding vanished, South Africa now finds itself at risk of unmitigated HIV spread.
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itself → vanish → spread
Now, at organizations like the Aurum Institute, interviews with Pienaar and other workers reveal how funding cuts have devastated the care apparatus.
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cuts → reveal → apparatus
Employment in HIV care and prevention has become precarious, and resources to slow HIV transmission are increasingly scarce.
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resources → become → transmission
As elsewhere in the world, this is creating a crisis of unemployment for Black LGBTQ+ workers, which itself creates higher risk for HIV.
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which → create → HIV
Gender-affirming care, which is a crucial tool for preventing HIV, has disappeared almost entirely.
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which → affirm → HIV
Until the second Trump administration, the United States government sent a bit more than half a billion dollars a year to the Republic of South Africa.
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government → send → Africa
Of the $580 million the U.S. sent in 2024, 78 percent ($455 million) went towards HIV/AIDS.
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percent → send → AIDS
But this money from America was hardly charity or lacking in self-interest.
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money → lack → interest
Because viruses know no borders, what happens with AIDS in the country with the most infections affects everyone on Earth.
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happens → know → Earth
Controlling HIV in South Africa makes the entire world safer by preventing the emergence of dangerous viral mutations, reducing the global burden of infectious diseases, and strengthening health systems that detect future pandemics.
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that → control → pandemics
Because viruses mutate rapidly when allowed to replicate unchecked, poorly controlled epidemics anywhere pose a direct threat to global health security.
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epidemics → mutate → security
South Africa also leads the world on another important front: medical research to address HIV.
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Africa → lead → HIV
The republic is home to more clinical trials than any other country for seeing how medications of all kinds (including Covid vaccines) impact those with HIV.
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medications → see → HIV
The profits of American drug companies depend on South Africans undergoing research trials.
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Africans → depend → trials
And after a year-and-a-half of dialing down HIV funding and only allowing it with many caveats which have caused major harm, the United States announced in June — during America’s LGBTQ+ Pride Month — that it will end all HIV funding in South Africa.
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it → dial → Africa
The ramifications of this will be felt globally for years to come.
asserted
ramifications → feel → years
They are already being felt by the millions of South Africans for whom HIV care has become harder and harder to find.
asserted
care → feel → whom
And the effects are most severe for those already on the margins of South African society: those already living with HIV/AIDS, immigrants, trans women, and the poor, including thousands of newly unemployed HIV prevention workers.
asserted
effects → live → workers
On January 20, 2025, Trump signed two executive orders: 14169, “Reevaluating and Realigning United States Foreign Aid,” and 14168, “Defending Women from Gender Ideology Extremism and Restoring Biological Truth to the Federal Government.”
asserted
Trump → sign → Government
Within hours of Trump taking the oath of office, the vast majority of workers for OUT LGBT Well-Being, which ran the Engage clinic, were told not to come in to work the next day nor to even open their work laptops again.
asserted
which → take → laptops
According to one, 82 of 86 workers were let go.
uncertain
workers → accord → one
…and 126 more, not listed.
The Aporia
