{"id":783,"date":"2026-07-21T14:06:16","date_gmt":"2026-07-21T14:06:16","guid":{"rendered":"https:\/\/americanlivingreport.com\/?p=783"},"modified":"2026-07-21T14:06:16","modified_gmt":"2026-07-21T14:06:16","slug":"how-the-culture-war-came-for-condoms-prep-and-hiv-testing","status":"publish","type":"post","link":"https:\/\/americanlivingreport.com\/?p=783","title":{"rendered":"How the culture war came for condoms, PrEP, and HIV testing"},"content":{"rendered":"

If the US wanted to be the world\u2019s police officer, then why not try to be its doctor too?<\/p>

Read more The truth about gut health<\/a><\/p><\/div>

Just two months before the invasion of Iraq in 2003, George W. Bush announced an ambitious plan to pump $15 billion into the global fight against HIV, stunning his allies in Congress, health advocates, and heads of state of the program\u2019s intended beneficiaries.<\/p><\/div>

The President\u2019s Emergency Plan for AIDS Relief, or PEPFAR, was the largest commitment by any nation in history dedicated to addressing a single disease, a disease that killed about 3 million people in 2003, most of them living in sub-Saharan Africa, and infected 5 million more. \u201cLadies and gentlemen,\u201d Bush proclaimed in his State of the Union address that year, \u201cseldom has history offered a greater opportunity to do so much for so many.\u201d<\/p><\/div>

On that, he was right. In the two decades to follow, PEPFAR would save an astounding 25 million people\u2019s lives through lifesaving HIV therapies, and prevent millions of babies from being born with HIV in the first place, all at a cost of about 0.08 percent of the federal budget.<\/p><\/div>

And yet, in the wake of the Trump administration\u2019s foreign aid cuts, one of the greatest achievements in American history is now at risk. PEPFAR, mercifully, still exists, saved from the sledgehammer by an outpouring of bipartisan support last February. But experts say the program has been transformed beyond recognition by countless small cuts, and the abrupt gutting of global health architecture, reshaped not by decades of accumulated wisdom around HIV prevention, but by at times absurdly petty ideology.<\/p><\/div>

Over the past year, more than 77 percent of PEPFAR grantees have lost funding or had their payments delayed, according to a survey released Tuesday by the HIV research group amfAR.<\/p><\/div>

Nearly two-thirds of grantees \u2014 especially those supporting vulnerable populations such as LGBTQ people, young women, and sex workers \u2014 said the cuts had disrupted their ability to offer HIV treatments and other services. The Trump administration released limited data showing a deep reduction in HIV prevention services, but a relative consistency in access to treatment earlier this year. However, this new survey paints one of the first pictures available of how PEPFAR cuts are actually being felt on the ground, and how the administration\u2019s priorities are reshaping who and what gets funded.<\/p><\/div>

According to the survey\u2019s authors, at least 1,700 HIV-related sites or clinics have shut down as a result of cuts. Well over 16,000 health workers \u2014 including those going door to door to make sure pregnant parents get tested for HIV or children get on treatment \u2014 have lost their jobs.<\/p><\/div>

Many organizations surveyed reported receiving emails when their PEPFAR grants were terminated, noting that their work violated President Donald Trump\u2019s executive order against \u201cunlawful diversity, equity, and inclusion.\u201d It appears, they say, that many of these groups were flagged not because they embraced the distinctly American concept of DEI in their work, but because their name or mission description included a phrase like \u201cgender\u201d or \u201cLGBTQ.\u201d<\/p><\/div>

A health clinic serving survivors of domestic violence in Mozambique, for example, might now be flagged just for using the phrase \u201cgender-based violence\u201d in their name. This may be part of the reason why even pregnant women \u2014 who even the Trump administration has emphasized as a critical demographic in its HIV goals \u2014 have lost access to services.<\/p><\/div>

Back in 2003, Bush defied conservative critics in his own party who attempted to redirect PEPFAR funding to abstinence-only programs. For decades, American presidents have been able to see past their ideology in service of saving lives. They largely understood that contraceptives like condoms and special interventions for those most at risk, including LGBTQ people, were necessary for stopping the spread of HIV. Under the Trump administration, this norm is unraveling.<\/p><\/div>

\u201cThis administration has zero interest in addressing clinical outcomes for vulnerable people with HIV,\u201d said Asia Russell, executive director of the advocacy group Health GAP, who noted that \u201cto be effective, HIV prevention and treatment services actually have to go where the disease is, and that risk is not evenly distributed,\u201d surging in certain geographies like South Africa or within key populations like trans people or young women. Getting support to these groups is \u201cmorally right,\u201d she said, but it is also \u201cthe only way to do effective HIV work, regardless of your stance on the morals or the merits.\u201d<\/p><\/div>

The fight against HIV is running on fumes<\/strong><\/h2><\/div><\/div>

When HIV aid does get doled out these days, it is distributed with far less transparency than in the past, and in ways that often appear to be ideologically or politically driven, both in terms of the populations they serve and the countries they operate in, rather than guided by best practices.<\/p><\/div>

In theory, lifesaving HIV care was exempted from sweeping aid cuts last year. But in reality, access to even the most basic HIV services and treatments has also atrophied across the board, while falling disproportionately on at-risk populations.<\/p>

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That\u2019s come both in the form of direct cuts and as a byproduct of broader disruptions to the kind of outreach services, testing, and socioeconomic programs that get patients in the door to begin with.<\/p><\/div>

\u201cYou can\u2019t cut pieces of the architecture of how PEPFAR functions and expect to maintain a really robust treatment program in the long term,\u201d said Jennifer Sherwood, director of research and public policy at amfAR. \u201cIf you cut the testing program, the prevention programs, the kind of services that allow people to stay in care and return to care, you\u2019re going to see that you can\u2019t maintain a treatment program.\u201d<\/p><\/div>

The number of people getting on treatment for the first time has sharply declined over the past year, even according to the administration\u2019s own limited data drop, while access to testing, contraceptives, and other preventative services \u2014 all critical to keeping infections down in the long run \u2014 face cuts that threaten their ability to function at all.<\/p><\/div>

To make matters worse, amfAR\u2019s survey shows that services designed for the populations most at risk of HIV \u2014 such as sex workers, LGBTQ people, young women, and teenage girls \u2014 have been disproportionately affected by PEPFAR cuts. Among those who lost funding, a staggering 90 percent of organizations that serve gay and bisexual men were forced to slash access to PrEP \u2014 which strongly protects against HIV infection \u2014 and many stopped offering it entirely. The same was true for over half of organizations serving pregnant women, whose children now face a higher risk of contracting HIV in the womb.<\/p><\/div>

The majority of new HIV infections are concentrated in these \u201ckey populations,\u201d as they\u2019re known in public health parlance, many of whom face stigma or other obstacles to obtaining care. \u201cOne really powerful aspect\u201d of how PEPFAR used to work, said Thomas McHale, public health director at Physicians for Human Rights, was that it consistently \u201cfollowed the science and followed the epidemiology\u201d to serve \u201cgroups that are at the margins of society.\u201d That approach appears to have been thrown out under the new administration, and in at least some cases, actively discouraged.<\/p><\/div>

McHale has been of PEPFAR cuts in South Africa in recent months, and \u201cwhat we saw was a system under severe stress and strain,\u201d he said. It is one in which a bisexual man stopped taking his HIV medications for weeks because the LGBTQ clinic he used to go to closed. \u201cHe just couldn\u2019t bear the stigma of accessing services in a place that\u2019s not meant for him,\u201d according to McHale. Similarly, a young woman was forced to wait in line for 10 hours just to refill her PrEP prescription.<\/p><\/div>

\u201cIf we\u2019re not focusing on preventing disease,\u201d McHale said, \u201cit\u2019s just a more expensive and more devastating challenge to address in the future.\u201d<\/p><\/div>

Some countries may soon stop receiving PEPFAR funding altogether<\/strong><\/h2><\/div><\/div>

As I\u2019ve written previously, the Trump administration has attempted to remake foreign aid into a dealmaking enterprise, one in which money flows directly through national governments rather than through large, western-led non-governmental organizations or NGOs.<\/p><\/div>

In theory, there are benefits to this approach, because it prioritizes the expertise of local health groups and policymakers who are often best equipped to evaluate and address the needs of those in their care. In practice, however, amfAR\u2019s survey shows that so far, under the Trump administration, local organizations have actually lost more<\/em> funding and been forced to close more sites than international groups have. \u201cThese cuts fell heavily on locally-based organizations\u201d while NGOs have fared somewhat better, said Sherwood, \u201cand that really runs counter to all of our global health goals.\u201d<\/p><\/div>

\u201cI\u2019m concerned because public health is no longer how we\u2019re measuring success\u201d when it comes to reaching PEPFAR\u2019s goals, said Jirair Ratevosian, a senior fellow at the Duke Global Health Institute who served as chief of staff of PEPFAR under the Biden administration. He is especially alarmed by the decision last month to end PEPFAR support for South Africa, which has the largest HIV epidemic in the world. The administration appears to have done so in part because of Trump\u2019s insistence that the nation is waging a nonexistent \u201cgenocide\u201d against white Afrikaners.<\/p><\/div>

\u201cHIV control is not their chief concern,\u201d said Ratevosian, who recently ran the numbers on a separate fissure with Zimbabwe, finding that cutting PEPFAR would lead to 75,000 new HIV infections in just one year. In South Africa, similar cuts could lead to over 2 million more infections over the next two decades, a toll that would invariably cross borders, and could threaten the world\u2019s immense, hard-won progress against HIV. \u201cYou can\u2019t have a global HIV strategy,\u201d said Ratevosian, \u201cif you\u2019re not engaging these countries.\u201d<\/p><\/div>

Priorities shift under any new administration, and it\u2019s not abnormal for an organization to tweak its language or services to adapt. But PEPFAR, the bipartisan program which began under Republican leadership, and thrived and expanded under three successive presidencies, including during Trump\u2019s first term, has never faced such turmoil.<\/p><\/div>

\u201cEven among organizations who didn\u2019t lose US funding, we\u2019re still picking up changes to the way they work, the populations they serve, the words they use,\u201d said Sherwood of amfAR. Her group\u2019s survey showed that nearly 80 percent of organizations that did not lose funding still altered the way their organization worked to comply with new policies. \u201cThis network of changes from the US,\u201d she said, \u201care prompting a lot of changes on the ground.\u201d<\/p>

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    The Trump administration\u2019s cuts to PEPFAR are reshaping the global fight against HIV.<\/p>\n","protected":false},"author":1,"featured_media":780,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-783","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-interesting"],"yoast_head":"\nHow the culture war came for condoms, PrEP, and HIV testing - American Living Report<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/americanlivingreport.com\/?p=783\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"How the culture war came for condoms, PrEP, and HIV testing - American Living Report\" \/>\n<meta property=\"og:description\" content=\"The Trump administration\u2019s cuts to PEPFAR are reshaping the global fight against HIV.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/americanlivingreport.com\/?p=783\" \/>\n<meta property=\"og:site_name\" content=\"American Living Report\" \/>\n<meta property=\"article:published_time\" content=\"2026-07-21T14:06:16+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/americanlivingreport.com\/wp-content\/uploads\/2026\/07\/e8366316047934d01562da98896f2178.webp\" \/>\n\t<meta property=\"og:image:width\" content=\"2400\" \/>\n\t<meta property=\"og:image:height\" content=\"2424\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/webp\" \/>\n<meta name=\"author\" content=\"admin\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"admin\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"9 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/americanlivingreport.com\\\/?p=783#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/americanlivingreport.com\\\/?p=783\"},\"author\":{\"name\":\"admin\",\"@id\":\"https:\\\/\\\/americanlivingreport.com\\\/#\\\/schema\\\/person\\\/7b970e3bc484fe2e26860a4380d70de8\"},\"headline\":\"How the culture war came for condoms, PrEP, and HIV testing\",\"datePublished\":\"2026-07-21T14:06:16+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/americanlivingreport.com\\\/?p=783\"},\"wordCount\":1831,\"commentCount\":0,\"image\":{\"@id\":\"https:\\\/\\\/americanlivingreport.com\\\/?p=783#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/americanlivingreport.com\\\/wp-content\\\/uploads\\\/2026\\\/07\\\/e154cf7e750aa763b6c75895184748f0.webp\",\"articleSection\":[\"Interesting\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/americanlivingreport.com\\\/?p=783#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/americanlivingreport.com\\\/?p=783\",\"url\":\"https:\\\/\\\/americanlivingreport.com\\\/?p=783\",\"name\":\"How the culture war came for condoms, PrEP, and HIV testing - 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