UNSTOPPABLE

Around the World and At Home

The first few months of 2025 have seen the dismantling of much of the progress in the HIV/AIDS community over the past 40+ years. Clinical trials, research, education, support services, and medical treatments were shut down with little notice, and little hope of revival. Jobs have been lost, accomplishments erased. The stated purpose of eliminating government waste and fraud has served only to hurt the most vulnerable people in our society, in the US and abroad. Because so many in this community fit into the definition of DEI — diversity, equity and inclusion — by virtue of being women, LGBTQ, or people of color, these draconian cuts have already proven to be life-threatening.

USAID was established by President John F. Kennedy to bring several foreign aid agencies under one umbrella. The singular accomplishment of George W. Bush’s controversial administration is a program that falls under USAID: the 2003 executive order creating PEPFAR, the President’s Emergency Plan for AIDS Relief. An example of what Bush termed ‘compassionate conservatism’ to combat AIDS in Africa, the idea was originally proposed by Dr. Anthony Fauci from the National Institutes of Health. Its effectiveness is not a debatable point. Between its inception and January 2025, PEPFAR has saved over 25 million lives, supported antiretroviral treatment for nearly 20.5 million people, and provided HIV-free outcomes for 5.5 million babies born to mothers living with HIV.

It’s one of the most successful global health initiatives in history. At least it was until January 2025, when its funding was cut off by the second Trump administration.

After the inauguration, I went back to several of the women in this book to re-interview them. When I talked to them after the election, they were worried and a little scared, not sure what a Trump re-election would mean for them. After January 20, they knew what it meant: life or death. Their anger did not surprise me, but the intensity of the rage was not like anything I’d seen before.

They watched their life’s work - whether a few years or decades - destroyed in a matter of weeks. And for those who live with HIV, the consequences were much more severe. No one epitomizes this situation more than Martina Clark.

Clark’s story begins in 1992, when she was diagnosed with HIV. Although living in San Francisco at the time, where AIDS was decimating the LGBT community, she believed that this illness was something that only affected the people around her. The doctor who delivered her diagnosis could give little information because she was the first HIV-positive woman he’d ever treated.

Like other HIV-positive straight women in this book, Clark had to find her own community. By necessity and by choice, she became an advocate “to stay one step ahead,” she told me. Clark wanted to find meaning in her diagnosis. In some ways, she had an advantage because being an HIV-positive woman, she was not impacted by homophobia.

It was easier as a straight woman to tell my story then. There was no stigma about me as a person.

Martina Clark addressing UN General Assembly, 1996 (photo credit: Martina Clark)

Her advocacy in San Francisco led to an opportunity to fulfill a long-time interest that was the focus of her college degree: international work. Clark became the first openly HIV-positive person to work for UNAIDS, the United Nations Programme on HIV/AIDS. Created by UN resolution in 1994, it began operations in 1996. Clark began working for them that year, as their original liaison officer. She also served as HIV in the Workplace Program Manager for UNICEF (globally) and UN Cares Regional Coordinator (Middle East and North Africa).

When I spoke to her in March 2025 about her work for UNAIDS, the anger was palpable.

People are dying already. Already new infections. How many babies will get HIV because they don’t have the $3.00 for treatment? Evil is the only way I can think of it. I’m certain things could be restructured for efficiencies, [but this is] callous and cruel. The damage is done and [we] will have to start over again…the way they’re doing it is evil.

Martina Clark, UN HIV Advisor, 2017 (photo credit: Martina Clark)

Because of Clark’s workplace vantage point, she sees the ripple effect of shutting down USAID in general and PEPFAR in particular.

UNAIDS work is impacted by the US pulling out of WHO (World Health organization), etc. They’re losing their funding, too…Other development agencies — UK, French, German, Swedish — might be able to step in. They might have people in place, but their specialties [which are different for every agency] might not be helpful.

Poor countries don’t have a lot of options. We pulled the rug out.

“Pulled the rug out” is a charitable way of describing the effects of cutting off funding for HIV prevention and treatment. UNAIDS has warned that discontinuation of funding will result in an additional 4.2 million AIDS-related deaths between 2025 and 2029. Even with the $400 million in PEPFAR funding restored in July 2025, those funds must be spent before the end of the fiscal year in October. It will be a scramble to call back staff as well as order and distribute medications and testing kits. That reprieve will likely be temporary, as the US State Department is developing plans to transform PEPFAR over the next few years into a platform for rapid detection and outbreak response to protect Americans from disease threats like Ebola, not HIV.

When we spoke that day, Clark still believed her work was valuable.

We fought this battle forty years ago. I know my work made a difference; it’s already been validated. I know it mattered. No regrets. Is that work now completely undone? Probably, some of it.

Most of her work was conducted thousands of miles away from where she now lives in Brooklyn. Clark understands that talking about HIV and AIDS in other countries may not register with people who still think of HIV as a gay issue.

I worry about the people who aren’t that angry. I’m so lucky because I have the privilege of being a white woman with a backup. I worry about people who are angry with no options.