This story was supported by the Pulitzer Center and the Fund for Investigative Journalism.
JOHANNESBURG, SOUTH AFRICA —
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. 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. This made Engage a “high-impact” clinic for distribution of the HIV prevention drug PrEP.
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.”
Today, it would be very hard to get help here, despite the welcoming-but-outdated signage. The clinic, once staffed full-time by professionals, closed abruptly during the first hours of the second Trump administration. Its replacement, an unrelated volunteer clinic called USpace, is open a mere four hours a week. They can do HIV tests here. But they have no HIV treatment, HIV prevention, or gender-affirming medication to distribute.
South Africans account for about a fifth of the
41 million people
living with HIV around the 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. Managing their healthcare is a matter of international concern and requires global coordination and an immense local network. 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.
Yet over the last year and a half, this crucial work has been stymied. By
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