On World AIDS Day 2025, humanity should be celebrating that there is a new shot available which offers six months of protection against the transmission of HIV, the virus which has already infected approximately 40 million living people and taken the lives of 44 million more.
Instead, public health workers are reeling from how President Donald Trump has helped HIV to circulate in more humans this year than last. The lethal ways the current U.S. health policy is harming the health and wealth of LGBTQ+ people worldwide will be felt for years, if not decades.
That’s because on the first day of his second term, Trump issued a stop-work order for all foreign aid and several orders that jeopardized the health outcomes of minority groups within the U.S.
The cuts were far-reaching yet highly specific. They reduced resources for short- and long-term health research conducted by the Centers for Disease Control and Prevention, universities, and community groups in the U.S. and around the world. Through the so-called Department of Government Efficiency’s gutting of the United States Agency for International Development, or USAID, the administration curtailed or ended funding for programs like the President’s Emergency Plan For AIDS Relief, also known as PEPFAR.
These cuts disparately harmed several distinct but often overlapping populations: LGBTQ+ people, immigrants, sex workers, and people living with HIV/AIDS. They were swift, halting scientific trials and critical services within days (or even mere hours) of their posting on January 20, 2025. And they were significant, contributing to acute medical crises, hunger, homelessness, or even death.
In the U.S., cuts to federal spending resulted in the cancellation of over $125 million in National Institutes of Health grants for LGBTQ-focused health research.
Across the globe, cuts to USAID are disrupting life-saving services and forced community organizations to close across the globe. In South Africa, transgender people immediately lost access to gender-affirming care, leading to forced detransitioning, body dysmorphia, depression, and even suicide. In Lebanon, USAID cuts are causing job losses among humanitarian aid workers, impacting medical care and disrupting development programs. In Uganda, people living with HIV have lost access to condoms, lubricants, medication, and even to the food that USAID once provided to people living with the virus (as those who are starving simply cannot take antiretroviral medication).
While there are lethal exceptions, often, the effects of these cuts are unfolding gradually over time. HIV is a slow-acting virus, and the deadliness of halting its prevention and treatment now will take years or even more than a decade to manifest.
But it’s possible to take a toll of the damage nearly 11 months later today on World AIDS Day, to better understand the damage done and the suffering and death still to come. By early 2025, Politico reported that the administration canceled 86 percent of all USAID awards. One analysis found that 71 percent of HIV-related activities globally were terminated, including several HIV treatment awards and most HIV prevention programs. Overall, there has been a huge drop in the number of people starting antiretroviral medication and a decrease in viral load testing, which is crucial for monitoring the virus and preventing transmission. Without the infrastructure of monitoring, documentation, and care, HIV is transmitting unchecked in the dark.
And it’s also possible to get a pattern of HIV’s rise by talking to people doing the work on the ground (or who recently returned from it), people living with HIV, and people who are both. In the United States, Europe, Africa, and the Middle East, Trump’s cuts are not merely harming these populations by reducing or eliminating services they receive; it is also harming them by taking away their jobs.
For instance, at one large university hospital we visited in the Midwestern United States, every single trans Black outreach worker — who had been integral in addressing high rates of HIV among Black LGBTQ+ Americans — had lost their job by May. In Europe, we found HIV nongovernmental organizations struggling not just with cuts from USAID, but cuts also dictated from Brussels and their own governments, as EU countries shifted money away from immigrants and foreign aid and toward NATO and Frontex, the ICE of the European Union.
In Lebanon, the executive director of an organization that helps some 600 people per month access HIV services and other care — including financial aid or case management for queer people experiencing violence — said they can no longer plan beyond eight months.
At a clinic in Uganda for “key populations” (the euphemism for LGBTQ+ people in a country where “aggravated homosexuality” is a capital offense), a medical assistant said the staff was cut from 15 to just four. When told that staff at a similar organization in South Africa had also been reduced to just four people — but from an original staff of 86 — one of the workers in Uganda could only laugh: “Wow, I thought we had it bad.”
The immediate consequences of the cuts are more economic than medical. For many, the cuts created an acute crisis of employment.
Research has long shown that people who identify as LGBTQ+ and/or living with HIV are prone to living in poverty. Often, the only work in the formal economy accessible to LGBTQ people — and trans women in particular — is to work in HIV prevention. Workers typically began as clients, then became volunteers, then stick with it for their career. These people often lack university or even secondary-school educations, and their jobs in HIV prevention are key to their economic and physical well-being, with salaries serving as lifelines for their families and economic engines in their communities.
And when the stop-work order came, they fell off an economic cliff that brought financial danger much faster than HIV ever could. This was true in every country where we reported.
In the United States, the cuts created a crisis of LGBTQ+ employment with a stark racial divide. In the same way DOGE’s cuts to the federal workforce overall disproportionately impacted Black women’s employment, the domestic health cuts particularly affected LGBTQ+ workers of color. Whereas the stop-work order led to job losses for Black and Latinx queer and trans Americans who worked directly with the public, the same has not always true for their supervisors who, in our findings and in scientific research about primary investigators and recipients of government health grants, were overwhelmingly white. Many of this latter group relied on data collected by Black and brown colleagues — in the U.S. and around the world — to do their work. But when those Black and brown colleagues lose their jobs, the white researchers were often able to take the data and pivot to other research projects or jobs.
“If you go on Grindr, you will see many of my former colleagues offering services.”
This racialized LGBTQ+ employment crisis for front-line Black and brown workers is global. For instance, in Uganda, some health care workers who avoided layoffs had their salaries reduced by more than 50 percent, while other laid-off workers still go to their jobs just in exchange for food. In South Africa, one person at the Johannesburg HIV-prevention organization where staff was cut from 86 to just four people said, “If you go on Grindr,” a gay hookup app, “you will see many of my former colleagues offering services.” These HIV prevention workers had turned to for sex work — as there were no other jobs available to them.
Gutting the funding of HIV prevention globally harms workers in the short term, and humanity in the long run, by undermining a novel chance to curb or even end AIDS. In early 2025, trials were completed in some countries for lenacapavir, an injectable drug that can prevent HIV transmission for six months. Often hailed as a “breakthrough” medication, the potential benefits of lenacapavir were profound: If given to enough people for a period of time, it could diminish or potentially eradicate HIV. At the 13th International AIDS Society Conference on HIV Science in July, the World Health Organization recommended widespread use of lenacapavir as soon as possible.
Tragically, right as it was ready to begin rolling out, the Trump administration “decimated the infrastructure of global HIV prevention programs by its destruction of USAID,” said Gregg Gonsalves, an epidemiologist at the Yale School of Public Health. Despite the administration backing some small rollouts of the drug (about 500 doses of lenacapavir were delivered each to Zambia and Eswatini, which have a combined population of about 24 million people), Gonsalves described Trump’s “support for Lenacapivir” as “a hollow promise to millions who are at risk of HIV infection around the globe,” and “a drop in the bucket for a drug that can be manufactured by generic companies for $40 a year. We need the programs and services that Trump cut put back in place” — and for workers to be hired back to distribute this new drug to their peers.
Over the last year, there has been an enormous decrease in those peer educators in Europe, Africa, and North America. USAID cuts took away money from their outreach in sex work “hotspots,” gay saunas, immigration processing centers, prisons, cruising grounds, food banks, and the many places where HIV lodges itself by people society has largely abandoned.
In Uganda, we witnessed an illustration of what USAID could be doing, what it’s no longer funding, and how people fighting HIV could be fighting it more effectively (without expending more human resources).
On November 21, the group Universal Love Alliance created a free STI clinic at a sex work motel in Kampala, where it gave condoms and lubricants to 200 sex workers, and tested 86 people for HIV, other sexually transmitted infections, and urinary tract infections. People with urinary tract infections and syphilis were given antibiotics on the spot. There were three positive HIV cases detected (who were all enrolled into treatment immediately), six inconclusive cases (who were scheduled for follow-ups), and 77 negative cases.
Of those 77, about 60 began daily PrEP, or pre-exposure prophylaxis, and left with a 30-day supply of daily HIV prevention medication.
But the encounter revealed three warning signs.
First, most of the 15 people working were volunteers and were filling in for people who used to be paid to do this work.
Second, some of the boxes of supplies were marked “USAID: From the American People.” These were the last of their kind from a vanishing supply which will not be replaced. Universal Love Alliance is able to get antiretroviral drugs from a hospital for free, but it is buying all of its other supplies (including PrEP) with private donations, which limits how often it can offer such free clinics (at a time when such clinics funded by USAID and the CDC has ended).
And finally, while giving dozens of sex workers 30 pills PrEp is a good thing, if the team had been able to provide lenacapivr instead, “the six-month injectable PrEP, you could have potentially improved patient outcomes, increased adherence, and reduced the burden of HIV prevention,” Ahabwe Lenard, one of the lab technicians pointed out. With lenacapivr, Lenard and his colleagues would only have to try to find the people they’d treated again in 180 days instead of 30 — just two times a year, instead of 12 — which would free up everyone’s time and money (in a very poor country) while further reducing HIV.
But the benefits of this new drug will not be felt if it’s not available and if there aren’t trusted community health outreach workers to explain and administer it.
On World AIDS Day, it’s clear whose lives, employment, and health have been most affected by Trump’s budget cuts.
But make no mistake: Viruses travel, and Trump’s stop-work order has put the entire human race at higher risk for HIV and AIDS.
This essay is part of the series Global Stop Work Order, which will feature reporting about how the Trump administration’s cuts are affecting LGBTQ+ health and HIV/AIDS in Africa, Europe, the Middle East, and North America. The series is supported by a Pulitzer Center Global Reporting Grant and the Fund for Investigative Journalism.
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