David O.

In central Gulu, just behind the House of Prayer for All Nations, there is a low-lying area that is at odds with the rest of the northern Ugandan city’s neatness and precision. This quarter is a jumble of mismatched, red brick structures. A few lack roofs and have been turned over to weeds that now stand taller than the walls.

The ground, a dirt even redder than the bricks, is cut through with ruts. They have been carved out by the streams of effluent that run down from the surrounding churches and shops each time it rains. Though there has been no storm on the day in early April when I visit, the odor of waste persists.

As tends to happen, this neglected area has become a refuge for Gulu’s marginalized. Drug users and sex workers of all genders have made a home of the sole bar with its bald pool table and sprung couches. Their clients and dealers know they will eventually turn up here.

So do the health workers. I have joined a handful from the nearby regional referral hospital in their last-ditch attempt to help protect the sex workers and drug users from getting infected with HIV.

The people they are reaching out to are those most at risk of infection. Which is why the health workers I am with have spent years developing services that make it easy for them to gain access to the tools that will help protect them. That includes regularly dropping off condoms and lubricants, but most importantly pre-exposure prophylaxis. The oral medicine, taken daily, can dramatically reduce the risk of infection.

David O. is hanging out at the bar, drinking beer, when we arrive. The 25-year-old tells me he does his best to make ends meet picking up painting and construction jobs. But when he still falls short, he turns to sex work. That’s why he started using PrEP in 2022.

If you use it well, you will not contract HIV. If you take it the way they teach you, it will keep our bodies safe from HIV.

Since January, he has been unable to access PrEP from any of the usual spots. Not the nearby referral hospital. Not the drop-in centers that provide specialized services for gay men, like him.

The health workers I am with confirm his fears: Those services are not coming back. They were paid for by the U.S. government. President Donald Trump’s administration has abruptly ended that support.

The health workers have scrapped together some money from another source, the Global Fund to Fight AIDS, Tuberculosis and Malaria, to conduct this last visit. They want to test as many people as possible for HIV. Those that are positive, they can still enroll in treatment.

For those that are negative, they have a few condoms they can hand out. And some messages about safe sex to share.

David is uninterested. He doesn’t even bother to get tested. He already knows he should use a condom when he is with a client.

But if it’s a condom, you bring your own money.

A packet of three condoms costs him 2,500 Ugandan shillings, or a little less than $1. That is not much more than he will make with each encounter.

He sees no choice but to take the risk of unprotected sex, or “going live,” as he calls it, and just hoping for the best.

He is also aware that his is not the only community affected by the Trump administration’s cuts. Across Gulu, HIV services are disappearing, awakening a dread that the virus will resurge. David suspects people are already casting about for a scapegoat. He knows who they will land on.

At the moment, we have fingers pointing at our back. Other people know us. They are calling for more discrimination.

As the health workers wrap up their outreach, they are taking not just the biological protection conferred by PrEP, but the less tangible security that vulnerable communities derived from embracing and advancing those programs. Proof that they were just as committed as anyone else in Gulu to preventing the spread of HIV.

Now they have no more protection.

We’re going to see what will happen. We just sit quietly