Today, Explained - The culture wars turn deadly

Episode Date: July 30, 2026

The US is intentionally losing a fight against HIV that could be won. This episode was produced by Kelli Wessinger, edited by Jolie Myers and Miranda Kennedy, fact-checked by Gabriel Dunatov, engineered by Patrick Boyd and David Tatasciore, and hosted by Sean Rameswaram. Activists highlight the lives at stake if Congress fails to fund HIV services in the U.S. Photo by Paul Morigi/Getty Images for Save HIV Funding Campaign. Listen to Today, Explained ad-free by becoming a Vox Member: vox.com/members. New Vox members get $20 off their membership right now. Transcript at ⁠vox.com/today-explained-podcast.⁠ Learn more about your ad choices. Visit podcastchoices.com/adchoices

What's Elon been up to lately? He says he's going to make a historically accurate version of The Odyssey by end of year. That's a work of historical fiction, by the way. He's suing Minnesota over a new law that protects people from having naked images of themselves generated by AI, a thing his ex-AI loves to do. And he's getting in fights with the economist over who's hated more, Musk or the media. Maybe some people do love with me. I don't care. A quarter billion people follow me.

I think a lot more people actually like me than don't. and I think a lot more people hate you and the media more than you realize. He's got time to do all that because he's no longer slashing and burning the federal government. On today, Explain from Box, we're going to take a look at one set of doge cuts, those to HIV treatment and prevention. Around the world, something like 1,700 clinics have shut down. 16,000 health workers have been laid off. People are dying, but somehow there's reason to be hopeful. Support for this show comes from Norwegian Cruise Line.

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Norwegian Cruise line, Chips Registry, the Bahamas, and USA. Support for the show comes from Chime. Chimms changing the way people bank by offering rewarding fee-free banking. You can join the millions, millions who are already banking fee-free with America's number one choice for banking. You can add to chime.com slash explain. That's chime.com slash explained. You can sign up now. It only takes a few minutes. Chime is a fintech, not a bank. Banking services and chime card provided by Chimes Bank Partners, Qualifying Direct Deposits required. Terms and Limits Apply, go to chime.com slash disclosures for details. This is Today Explained. Sarah Hirshander is a reporter at Vox, and her most recent reporting is on how we're intentionally losing a fight we could win.

I think we should start in 2003. And the reason why I think we should start there is that that's when the U.S. got involved in this so-called fight against HIV. 2003 was when HIV was surging across sub-Saharan Africa. If you look at a chart of like infections and deaths from AIDS at the time, it is like at the top right in this moment. Millions of people were dying each year. Southern Africa now has the fastest rate of AIDS growth in the world. Today on the continent of Africa,

nearly 30 million people have the AIDS virus, including three million children. It was also just a few months before the U.S. invaded Iraq. We had George W. Bush, famously a Republican in office. He's giving a state of the Union in January, and to the surprise of pretty much everyone, he decides to allot $15 billion of U.S. funding to this global fight against HIV.

Ladies and gentlemen, seldom has history offered a greater opportunity. to do so much for so many. He was working with a bunch of medical experts behind the scenes, including someone people might recognize, Anthony Fauci. And that was when the U.S. really, like, put its foot in the door. And it ended up being a huge success. If you think about that chart I mentioned earlier, we're at the top of infections right now.

It goes down after 2003. And PEPFAR, which is what the program ended up being called, the president's emergency plan for AIDS relief, which describes any. anything that the U.S. is giving to this sort of fight against HIV, just expanded, became better as time went on. Sure, there were problems over time, but every presidential administration after Bush, after 2003, continue to provide funding through this program. And people love to, you know, remember that George W. Bush may be responsible for the deaths of hundreds of thousands of people in his Iraq war.

But how many people may he have saved through PEPFAR? Yeah, this is the crazy thing. It might have been the best thing that a U.S. President has ever done. If we're looking specifically. Say it again. Don't make me say it again, Sean. The one of the, or perhaps the most consequential things, arguably the best thing that a U.S. president has ever done. I like to say it was a rare W for George W. Bush of 25 million people. 25 million.

That's how many people have been, whose lives have been saved because of Pepper. far services. And you can't even count the number of people, many more millions of people who probably didn't even get HIV in the first place because of these all-important prevention services. Those are like World War numbers, Sarah. It's crazy. It's so crazy. Okay. An incredible win that maybe George W. Bush doesn't even get enough credit for. But in his defense, they don't kill the program in Obama won. Obama two, Trump won, Biden won, but then what happens in Trump two when Elon shows up with the chainsaw? Yeah, so PEPFAR, at least at the very beginning, was not immune from Doge and from these broader major cuts to U.S. foreign aid that was led by Elon Musk.

When he first came in, Elon Musk decided to freeze pretty much all U.S. foreign aid, and PEPFAR was included in that freeze. People were so worried about it and they were so much uproar because, again, this was always a bipartisan program. The out roar was big enough that they decided not to kill PEPFAR entirely, but what we're seeing now over a year later is that while PEPFAR still technically exists, it's been entirely reshaped under the state. the Trump administration. And that refers to both funding. There's just less funding than there used to be. That refers to these all-important preventative services that stop people from getting HIV in the first place. When our staff had to be pulled away with immediate effect, it meant that the patients were left stranded. Imagine if you no longer get your HIV treatment and it's going to cause a lot of damaging your body and you end up dying. And it also comes to

the kind of groups that are being served with specialized services. So something that we've seen under the Trump administration that's quite unprecedented is that the groups that are most at risk of HIV that refers to, for example, young women and teen girls, it refers to sex workers, it refers to the LGBTQ community. People who are getting specialized services as part of, like, just epidemiological wisdom on how to fight this, are seeing unprecedented cuts. They're They've been disproportionately affected. And we have reasons to believe that that is probably because of the Trump administration's ideology. They've been particularly targeting these sort of groups.

So we're also seeing kind of a reshaping of how prevention is distributed, how treatment gets distributed. Right. Your headline was how the culture war came for condoms, prep, and HIV testing. Tell us more about how this particular life assessment. saving initiative that the United States got into in 2003 became a part of a culture war. Yeah. I mean, there's a lot of things that can make one angry about what happened here. But this part I found to be sort of the most surreal. And that's the fact that under the Trump administration, a rule that had long been in place under Republican administrations around how the U.S.

distributes foreign aid, it's called either the Mexico City policy, if you're a Republican, the global gag rule, if you are a Democrat, typically how they refer to it. For a long time, it kind of shifted how foreign aid was distributed, depending on if an organization supported abortion services. That was like where the ideological battle lied. Under the Trump administration, that was expanded threefold, maybe even more than that.

He explicitly changed that rule to also include any organization that so much as mentions abortion, any organization accused of promoting gender ideology and any organization that could be accused of promoting DEI. And what we're seeing now is that it appears that that rule is now affecting these at-risk communities. So a lot of groups are getting these like weird emails saying that they don't comply with DEI policies for reasons like that. We're also seeing, for example, gender-based violence clinics who are changing their language. and feel like they might be getting flagged

because they have gender in their name, potentially. I mean, something that I cannot stop thinking about is the fact that over 90% now of organizations that serve gay or bisexual men have had to cut their prep services because of these cuts. And prep is a pill that people take to prevent HIV. This is really important. It's key to lowering case numbers, lowering infections.

It's key to the fight against HIV, and we're seeing it being decimated in a lot of the communities that need it most. The question is no longer whether we can end AIDS. The question is whether we choose to end AIDS. The ends is no longer limited by science. It's limited by inequality, by political choices. What I find crazy is that under his first administration, Trump was actually pretty, good on HIV, both abroad and within the United States. It was almost a pet issue for him. I think he wanted, like, it's hard to say exactly what happened behind the scenes, but I think it ties to his sort

of seeding of control to Elon Musk at the very beginning of last year. And then I think a lot of people probably in his ear who've been clamoring for changes for a long time, oftentimes when you sort of confront the administration about these changes, and I have spoken to the State Department about their sort of HIV funding, they will tell you that this is because, you, that this is because, there were problems with PEPFAR to begin with, that it was too directed by sort of liberal or liberal-coded nonprofits from the United States or from Europe, and that these countries ought to be spending money on their own health care. And this is like a change that we've always needed. And you know, there are some limited elements of truth to that. There are reformers within PEPFAR that for many years

have called for countries to take more ownership of their own health programs for like logistical reasons. It just makes more sense for it to be run by a country there. And that's something that the Trump administration has been advocating for. While they might be saying in their rhetoric that they still care about HIV prevention, particularly in certain communities, it's being deeply affected on the ground in ways that are going to set people back for probably a long time, unfortunately. But this isn't something that can't be undone? Yes and no. I think some of the damages unfortunately already done. But at the same time, if we remember 2003, we know how quickly things can come together to.

And that's possible as well in the future. Again, especially because we have all of these new sort of interventions. So while things are really scary right now, it definitely doesn't mean that that things can't change moving forward. The aforementioned reason to be hopeful when we're back on Today Explained. Support for the show comes from tachiatry. When your mental health is suffering, therapy can help, but sometimes it's not the whole answer. Talkiatry gives you access to psychiatric care

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This product is not intended to diagnose, treat, cure, or prevent any disease. You're listening to Today Explain. How about an HIV vaccine for some hope? Well, scientifically, we're in a more exciting time than ever when it comes to developing an effective HIV vaccine. There are challenges, both in terms of the actual research and obviously the kind of funding environment around it. But in terms of the scientific roadmap towards getting a truly effective vaccine, researchers have never been more excited than they are today. Science journalist Ailey Dolgan wrote about it for Vox. I mean, basically since the day that we discovered the virus over 40 years ago, people have thought, well, it's an infectious agent.

We should try to develop a vaccine. And pretty quickly, people narrowed in on the obvious target, which is a protein called envelope. It's the protein on the outside that the virus uses to kind of latch on to our. cells and infect ourselves. And so it seemed like, okay, well, we found the virus. We found this great target on its surface. You know, we should be able to get a vaccine. But here we are 40-plus years later and it didn't work out that way. Right. I mean, as a general consumer of the news, I don't feel like I'm often reading about an HIV vaccine. What have been the greatest barriers to its success? I think what scientists realized in recent years is that they kind of needed

to go back to the drawing board. There were several high-profile attempts in years past, it's been a while, where they thought, okay, we've got a prototype vaccine, let's put it into large efficacy trials in Africa or in India, and put tons of money and effort and resources into it only for the vaccine to come up empty and fail in those trials. And so the scientists thought, okay, whatever we're doing isn't working. This envelope protein that we thought was the ideal target. We still think it's a good target, but something about the targets that we're going after within it are not eliciting the type of immune responses that we need. So we need to really do our immunological homework, do the analysis, and figure out what it is exactly that we

need to get an effective product. And what is it? Well, HIV, when it comes to its envelope protein, most of it is basically kind of a decoy. The part that the immune system sees changes really easily. It's not that important to the virus so they can just mutate. And so whatever we would try to go after it, our vaccines wouldn't work. And so when scientists then looked deeper into what it is that gets you kind of a truly effective immune response, the kind that is going to neutralize all the different viruses. that are out there, all the HIV viruses that are out there,

with all its variability, they realized that we were kind of going after the wrong part of the envelope protein. And the part that gets you the kind of immune response we need is kind of hidden and only a small minority of people who are naturally infected develop those immune responses. And so the key was what we can now see in those rare individuals is that they have these immune responses, but it's even more complicated because they don't just get them right away.

What the immune system does is it kind of matures over several months, even years, as it learns and evolves to recognize those key parts of the virus. And so in order to do that in a vaccine, researchers now think they basically need to give a series of components, kind of a series of different pieces of that. envelope protein in the right order with the right timing to kind of nudge and carve out exactly the immune response that we want. And they think they basically know how to do that, although there's a fair amount of trial and error that will be necessary going forward to

kind of refine that strategy. After years of research, a breakthrough has finally been reached. On the medical watch, a new HIV vaccine offers hope for eliminating the disease. How big a deal is this moment for the people who've been at it for decades, if they're even still around? Yeah, I mean, the HIV vaccine research field has a lot of old timers, that's for sure, both here in the United States, but also in South Africa. There have been researchers like someone at the University of Cape Town, an infectious disease specialist I spoke with named Linda Gail Becker. She's been at this for decades, and she told me how she was so. excited. They had finally developed this first in Africa designed vaccine trial with the components discovered by African scientists. And they were all set. She had gone to the manufacturing plant

and seen the vaccine getting made. They were all meeting in Tanzania last year at the beginning of the year just to kind of work out the last details. And that's when President Trump, you know, got back into power and signed his executive order disbanding USAID. And the thing is that this trial was reliant on a $45 million grant from USAID, and it all kind of disintegrated before their eyes. Now, Ailey, we came to you for hope. No, we can't just go back into this death spiral. Oh, I'm sorry. I mean, they have salvaged some of the trial. They were able to get some funding from the South African Medical Research Council

and some nonprofits stepped up like the Gates Foundation and the Welcome Trust. But it's, you know, it's a lot less money. And one of the kind of weird things about right now is that the scientists are more excited than ever. They think they know what they need to do, but they need the funding to do it. But you also mentioned that they're like research challenges.

What are they? Well, the field is at this trial and error period, where they want to do a lot of these small-scale trials to prepare for the big one, once they figure out the right pieces to put into the final product. I'd say, you know, getting those trials funded remains a huge challenge, and especially because one of the key technologies that could really speed up this research, namely MRNA, is also under attack politically. MRNA enters the chat. The vaccines for COVID-19 cleared the threshold for emergency use in less than 11 months. The secret behind this speed is a medical technology that's been developing for decades, the MRNA vaccine. Growing backlash over President Biden's vaccine mandate. After reviewing the science and consulting top experts at NIH and FDA, HHS has determined that MRNA technology poses more risks.

and benefits for these respiratory viruses. Oh, God, yeah. So it's not just that the U.S. is pulling out from HIV funding generally, but now we're talking about MRNA vaccines. And the key advantage here of MRNA is kind of the same thing that was the key advantage with the COVID fight. It's really fast. I mean, if you want to create a vaccine,

you just enter the string of genetic letters into a computer. and you can order the sequence and basically manufacture the vaccine very quickly. Obviously, HIV is not an emergent pathogen like COVID was, but the researchers are at this point now where they want to run small-scale trial, do the analysis, learn from it, design the next vaccine, and then run another small-scale trial. And the MRI lets you kind of get from one trial to the next really quickly in a way that if you're using other vaccine technologies,

it can take a year or two just to manufacture your product for the next trial, and that would really slow things down. But of course, we've got a vaccine skeptic heading our health department and MRNA vaccines in particular have become part of the, you know, the COVID fights and the culture wars. So it's especially fraught as we pull away from not only HIV research generally, but MRNA technology more specifically. Well, let's do some alternate history here just for fun. Let's just say there is someone who flips this switch and there is a resumption of the funding levels that we've seen in the past.

If not, who knows, more funding. Let's say with all the money in the world and the support, what are the impediments? How soon do we see this? what kind of difference does it make? How many millions of lives do we save? I mean, at the moment, over a million people are still dying from HIV-AIDS every year. So a truly effective vaccine that could have, you know, even a 50% efficacy would save hundreds of thousands of lives every year. There are still real scientific issues.

I mean, some of the vaccines have caused some weird side effects. They're trying to work out what that's all about. They need to figure out all the right pieces and the components. At the moment, in order to kind of nudge the immune system in the right direction, it takes many shots up to eight in some of the monkey studies. That's not really feasible, so they need to get that down to, I don't know, three, say. But there are technologies like slow release depots that you could say, implant in your arm and it would release the pieces of the vaccine over the,

course of months in the right order, at the right time. And there are companies that are developing that technology. So I think with the right minds being focused on this problem and with the adequate level of investment, I truly think we will have a vaccine within a decade. And then we get to save millions of lives. And then we get to save millions of lives. Both Ailey and Sarah wrote about the fight against HIV recently for Vox.com, which is also the engine that powers today explained. Kelly Wessinger made this episode. Jolie Myers edited with help from Miranda. Kelly Wessinger made this episode. Jolie Myers edited with help from Miranda Kennedy and David Tadishore and Patrick Boyd mixed. Gabriel Dunatob did the due diligence. I'm Sean

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