Thirteen months into the second Trump administration, science, medicine and public health have been hijacked by a cadre of grifters and ideologues and by the politicians in obvious thrall to both. Federal institutions have been all but dismantled. Researchers have been defunded en masse and the universities that support them deliberately destabilized. Discourse on crucial scientific questions and key public health challenges has been stifled. And, along the way, trust has been broken between scientists, the nation’s leaders — and the people that both are supposed to serve.
It’s tempting to view this undoing as temporary. Americans love science and revere innovation, almost as a rule, and politicians of every stripe have spent the better part of a century promoting and protecting both. However imperfect the resulting system was, hardly a modern convenience exists that can’t be traced back to it: central air conditioning, the internet and ChatGPT; polio vaccines, statins and weight loss drugs; the human genome sequence and CRISPR gene editing. The National Institutes of Health alone generates about $2.50 in economic returns for every dollar of investment. It’s also the largest government-funded biomedical research agency in the world, and until recently was the envy of scientists across the globe.
The president’s attacks on this legacy have been relentless and all-encompassing. He has turned the federal health department over to Robert F. Kennedy Jr., the nation’s most prominent anti-vaxxer. For months, President Trump’s Office of Management and Budget all but froze operations at the National Science Foundation and the National Institutes of Health. His newly established so-called Department of Government Efficiency, or DOGE, fired thousands of civil servants from The Food and Drug Administration and the Centers for Disease Control and Prevention, in a process that was wildly disorganized, frequently unlawful and needlessly cruel. Global health initiatives were also eviscerated.
Stacked against these measures, the administration’s explanations — which focus on cutting waste and eliminating so-called woke politics from science — have been inadequate and disingenuous.
It can be difficult to imagine a future in which American science does not prevail. But, as the president’s many critics have warned, institutions like the C.D.C., F.D.A. and N.I.H. will be far more difficult to rebuild than they have been to destroy — especially if their intended beneficiaries lose all faith in them or forget why they existed in the first place.
The current administration seems to understand as much. Top officials have taken pains to describe the nation’s scientific bodies as corrupt and ineffective and the nation’s scientists as elitist and excessively woke. “Science and public health have achieved much more than current leaders seem to recognize,” says Tom Frieden, author of “The Formula For Better Health” and president of the public health nonprofit Resolve to Save Lives. “We actually know a lot about how to make America healthier. But very little of that knowledge is in line with what the current administration has done so far.”
Nowhere is this disconnect on fuller display than in the long war against H.I.V. Forty years ago, the infection was a mystery and a death sentence. Today, thanks to a combination of biomedical breakthroughs and diligent, boots-on-the-ground public health (testing, education, robust social safety nets), it is a chronic but manageable condition that really only flourishes among society’s most marginalized groups.
The first Trump administration vowed to finally end the American H.I.V. epidemic, no later than 2030, by doubling down on prevention efforts in the hardest hit communities. The resulting initiative has clearly paid off: Transmission rates are down in the targeted ZIP codes, according to the National Minority AIDS Council, a nonprofit devoted to stopping the virus’s spread. Racial health gaps are narrowing as a result, and because prevention is cheaper than treatment, money is being saved.
The second Trump administration seems determined to reverse course anyway.
On March 20 of last year, Kathryn Macapagal, a clinical psychologist and a faculty researcher at Northwestern University’s Feinberg School of Medicine, was sitting at her in-laws’ dining room table when her phone and laptop began pinging and ringing furiously.
Ping. The Adolescent Trials Network, a massive research apparatus focused on treating and preventing H.I.V. infection in teenagers and young adults, had been abruptly closed. The network was responsible for several studies that Macapagal and her colleagues were collaborating on.
Ping. A close colleague’s 10-year study on H.I.V. and substance use in L.G.B.T.Q. teenagers and young adults was now suspended. So was another project on reducing H.I.V. risk in relationships.
Ring. Another of her projects, on how to improve the measurement of sexual orientation and gender identity in federal surveys, was also done for. So were at least two fellowship programs for early-career scientists who wanted to specialize, as she did, in L.G.B.T.Q. health, and dozens of other projects affecting just about everyone she worked with or knew professionally.
Her husband, Dan (also a scientist, also reliant on N.I.H. funding) paced frantically behind her, as she announced each new bit of carnage. “At this rate, you’ll be out of a job by dinner time,” he said. “Oh my God. What are we going to do?”
“I cannot go there right now,” she replied. She was determined to remain calm. She was also too stunned to panic, although in truth, she was not surprised. Her research sat in just about every one of the administration’s cross hairs: All of her projects included the new red-flag terms and most of the researchers on her staff fell into at least one disfavored category, if not several. All of their salaries (including her own) were reliant on N.I.H. funding and all of their jobs were now gravely imperiled.
And not just theirs: Federal grants were the lifeblood of academic research. They supported scientists and students, institutes and administrators. They covered overhead costs. It was not uncommon for one person to be funded by several grants, nor was it rare for professors like Macapagal, working at elite universities like Northwestern, to be wholly dependent on grants that had to be renewed every few years. It was a deeply precarious arrangement, sustained for decades by the certainty that, come what may, the federal government would honor its commitments.
When the dust finally settled, four of Macapagal’s grants had been terminated, nearly a quarter of her salary was gone and a project she had spent many months developing was on seemingly permanent hold. As they struggled to make sense of what was happening, she and her colleagues found themselves drawing grim battlefield analogies: It was as if a bomb had gone off and some of them were dead on the field, while others, like her, were severely maimed. “One colleague who lost everything told me that he thought I actually had it worse,” she said. “Because, you know, if you’re going to die, it’s probably better to do it quickly.”
Of the 1.2 million people living with H.I.V. in the United States, more than 60 percent are Black or Latino. Transgender women, gay and bisexual men and teenagers and young adults of color face the greatest overall risk of contracting the virus in any given year.
Those inequities are no mystery: less access to health care, more social stigma and a negative feedback loop, wherein a higher prevalence of the virus in certain communities begets a higher prevalence of the virus in certain communities. But resolving them is no small feat.
In the years leading up to 2025, as she tried to do exactly that, Macapagal was consumed by several thorny challenges. A troubling dichotomy had emerged since the medication that prevents H.I.V. transmission (known as pre-exposure prophylaxis, or PrEP) first became widely available. Within the gay community, middle-aged white professionals had embraced the treatment as an ordinary component of overall health and wellness. But younger adults, immigrants and racial and ethnic minorities still had not.
“It’s not unlike birth control when it was first introduced,” said Jim Pickett, a board member of TaskForce, an L.G.B.T.Q. youth center on Chicago’s West Side, and a collaborator of Macapagal’s. “It’s pretty straightforward as a treatment, but it’s attached to all of this cultural baggage that makes it challenging to get across.”
In 2018, when PrEP was approved for adolescent use, Pickett and Macapagal began searching for ways to overcome these challenges. They knew teens would be an especially tough sell. Health care systems intimidated the boldest of them, sexual identities were still developing at that age and this particular form of protection could easily become a source of embarrassment or even shame.
Among others, they enlisted Skai Underwood, TaskForce’s dance instructor and youth engagement specialist, in their quest.
Underwood, who was assigned male at birth, knew by the age of 5 that she was a girl, but did not medically transition until her early 20s. She was intimately familiar with the shame and isolation that gay and transgender people often faced: how even friends and family would signal their rejection when you declared yourself, how that rejection could lead you to retreat inward. Her own goal was to help TaskForce teens resist that impulse, so that instead of hiding, they might thrive.
To her, the solution to Macapagal’s public health conundrum was clear: If you wanted to teach teenagers — or anyone else — to take safe sex seriously, you had to convince them that there was something to protect in the first place. “What it really comes down to is self-love,” she told me when I visited TaskForce in November.
With that in mind, she, Macapagal and Pickett created a two-pronged public health initiative called PrEP-4-Teens. The first prong involved a media campaign linking safe sex to empowerment and joy. The second wove an L.G.B.T.Q. sexual education curriculum into a suite of community-building activities. “They basically come together to dance and make art,” Underwood says. “We celebrate queer identity and then, in between all of the fun, we teach them how to protect themselves.”
The program’s early results were promising: Among other things, participants came away with an understanding of PrEP and a sense that it was no more shameful to use than condoms or birth control. But before they could scale it up, or study it in greater depth, a new administration began.
On his first days in office, the president issued a flurry of executive orders rolling back transgender rights and bringing federal diversity, equity and inclusion initiatives to an abrupt end. By many accounts, the DOGE officials tasked with implementing those orders had little to no understanding of the projects they were supposed to evaluate. “They seem to have confused D.E.I., which is about diversifying the work force, with health equity, which is about reducing health disparities in marginalized communities,” Amy Knopf, a professor at Indiana University’s School of Nursing, told me. “They’re making it so that you can’t study certain groups without violating these edicts. But you can’t really tackle H.I.V., or any number of other conditions, without looking at those exact groups.”
In the weeks after the March 20 Massacre (as some of them had taken to calling it), Macapagal and her colleagues began working furiously to cover as much and as many of their salaries as they could. The main conference space morphed into a war room of sorts, as Macapagal’s boss, Brian Mustanski, tried to match any open position or bit of unused grant money he heard of with whichever recently defunded staff member who was qualified.
Macapagal’s own job was saved by one colleague who stepped up without even being asked. “We have some money that we’re not using yet, and some work that you could definitely do,” the woman explained. “Let me add you to that project.” She accepted, and for many months afterward, would tear up just recalling the kindness.
In April, the federal government froze some $790 million in funding for Northwestern, without notice or explanation. The university was apparently being accused of antisemitism and of racism over its diversity initiatives, but it was unclear whether the freeze was related to those charges, and no one seemed to know when, or whether, or how the funds would be restored. Researchers would have to tighten their belts as much as possible, university officials explained, while they tried to sort out the situation.
Among other things, the new strictures meant that Macapagal would not be able to pay Jim Pickett for all the work he had done on her projects. Pickett, who had presided for long decades over a community center that prided itself on perseverance, took the news in stride. “Don’t worry,” he said. “We’ll make do.” But Macapagal felt awful.
Nobody outside the scientific community seemed to realize what was happening. Friends and family had all tried to reassure her that everything would be fine in the long run, that she just needed to hang in there until the midterms, or the next presidential election. She found it exhausting to explain how irreversible the damage actually was. They had lost years of research in a matter of weeks. Whole labs had been closed and successful, decades-long careers ended — and none of it appeared to have anything to do with the quality or import of the research itself. The decisions were political and ideological. They were also arbitrary and needlessly cruel.
Trust had been broken as a result, at just about every level of the scientific enterprise (between study participants and scientists, between scientists and universities and between universities and the federal government). Whatever came next, it seemed extremely unlikely to her that any of them, let alone all of them together, would be able to just pick up where they had left off.
In the meantime, those who were left — the maimed but still breathing — leaned on one another. When they were advised to pre-emptively change the language in their public-facing documents, Macapagal and her colleagues did the edits together, grousing in unison over the aggravation of revising terms like “inclusion criteria” and the moral grossness of erasing the word “transgender” from their work.
It was not the first time their field had been forced to make such compromises; the eldest among them remembered culling words like “gay” and “sex” back in the early 1990s. But this was different. In the past, even if they had to change a word or two, they still got to do their research. Now, Macapagal found herself contorting a study on H.I.V. vaccine misinformation (her attempt to get ahead of the hesitancy that had plagued Covid vaccines) into something else entirely.
She found herself making other changes, too, including dying her pink hair back to a soft brown. “It might be safer for me to not be so out there with how I look,” she said. Some of her friends and colleagues were taking similar precautions. They were losing facial piercings and gay pride stickers. They were also changing slide deck images to include more white people, even when the conditions they studied did not, for the most part, affect white people. It felt gross because it was gross, but what else could they do? They had families and mortgages and work that they still wanted to complete. They knew people who had been doxxed and threatened — and worse — just for studying gender-affirming care. And they were anxious and, in some cases, afraid.
As spring bled into summer, and the university explained that it could no longer provide offices with free coffee or free tissues, Macapagal turned a worried eye to her own lab, and began doing what she could to help each person secure other jobs. It was a risky gambit: If they did leave, and her funding was then restored, she’d be hamstrung. But she thought of the group as a kind of family, and she wanted to protect whomever she could.
Her lab manager, Andrés Alvarado Avila, was here on an H-1B visa and if his funding was cut, would have just 60 days to find another job, secure an exception or return to Mexico. Her project coordinator, Zach Buehler, was only a few years out of college. She found herself wondering if it was fair or right to encourage him down a career path whose future looked so bleak. Like many of her lab members, Alvarado Avila and Buehler were gay men. As anachronistic as it sounded, she could not help but worry about what that might mean for their futures, in an America that was less recognizable by the day and that seemed to be coming for them all.
In the past year or so, scientists funded through the National Institutes of Health have developed potential treatments for pancreatic cancer, broke the logjam on Huntington’s disease, shepherded a male birth control pill through clinical trials and saved a baby’s life with the first personalized gene editing procedure. In a different time and place, any one of those breakthroughs would have been hailed as the triumph of an epoch, and might have lured a new generation of talent to the cause of scientific research.
Instead, six years after the pandemic began and one year into the second Trump administration, we have the opposite: seasoned scientists fleeing the profession (or the country), and younger prospects deciding not to pursue it at all. It’s impossible to say what new medicine those minds might have developed or what wicked problems their efforts might have solved.
What seems clear is that Americans have entered a grim new era, one where science itself is a political weapon, rather than a tool for the collective good. It would be simplistic to argue that the two — science and politics — should be wholly disentangled (as a human endeavor that involves trade-offs and requires public support, science is inherently political). But real data and hard, neutral facts still drive the work that most scientists do, and the best of that work should still frame public discourse and ideally, inform public policy. And right now, it does not.
This past June, the F.D.A. approved the latest version of PrEP: an injection that patients would only need to receive twice a year and that appeared to work even better than its predecessors at preventing infection. In July, the N.I.H. director, Dr. Jay Bhattacharya, laid out yet another strategy for eliminating H.I.V. in the United States. Rather than pour limited resources into more basic research, his agency would simply deploy existing PrEP medications. “Why is there any reason to wait?” he asked on his podcast. “Why don’t we just really commit to ending the H.I.V. epidemic, actually doing it with the tool kit we have now?”
The director’s epiphany frustrated H.I.V. specialists. He was right about the import of using existing tools more effectively. But many of them, including Macapagal, had been working on exactly that challenge when Dr. Bhattacharya’s agency cut their funding back in March. What’s more, almost all of the current administration’s stances — not only on science, but on health care and public health, immigration and social safety nets — were anathema to Dr. Bhattacharya’s stated goals.
If health officials wanted to extirpate H.I.V. from the United States, they would increase access to health care, ramp up testing and education and fortify the social safety net.
At every turn, Trump and his deputies had done the exact opposite. They had tried to eliminate hundreds of millions of dollars in funding for H.I.V. testing, treatment and prevention services. They had cut Medicaid by hundreds of billions of dollars and played chicken with Democrats over Affordable Care Act subsidies. They had also weakened the social safety net, sown terror in immigrant communities and upended public health programs just about everywhere.
If those policies persisted, even as the newest PrEP medication is made commercially available, H.I.V. will continue to linger. “Most of what we’ve done to beat back AIDS comes down to this extremely fragile safety net, that is right now being destroyed,” Dr. Jon Mannheim, a pediatric H.I.V. specialist who sometimes collaborates with Macapagal, told me when I visited Chicago in November. Illinois was facing one of the largest Medicaid cuts in the nation, and his own clinic was already bracing for impact. Among other things, he worried that fewer social workers would be hired for even less pay than before.
Without them, he said, the whole system might collapse. Patients who lost health insurance would have a harder time getting into the fail-safe programs meant to keep them on PrEP (and to keep AIDS at bay). The pregnant women he treated would lose their main point of contact for a whole suite of stabilizing services. “I don’t know how many babies would have to be born with H.I.V. for the federal government to care,” he said. “But I guess we’ll find out.”
In the meantime, his Latin American patients were still avoiding the clinic altogether, months after I.C.E. had descended on the city. He had lost several of them to follow-up care over the summer. The one that troubled him most was a 10-year-old girl from Venezuela who lived in a car with her mother and whose H.I.V. infection might have already progressed to AIDS. “I have not seen her in months,” he said. “She could be dead by now.”
A few miles away in West Chicago, the TaskForce community center was facing similar challenges. They had lost some $500,000 in anticipated funding, thanks not only to state and federal budget cuts, but also to a new reluctance among donors. “We heard a lot of, ‘Hey, these dollars that we thought that we could give you we actually can’t now, because you’re L.G.B.T.Q., which is a no, and BIPOC [Black, Indigenous and people of color], which is also a big no,’” said the center’s director, Chris Balthazar.
They were getting by, but the strain of moving through the world with so many targets on their backs was starting to show. One of their regulars, a 15-year-old Haitian boy, had nearly taken his own life after his parents were abruptly deported. And Underwood had detected a new reluctance in some of her L.G.B.T.Q. students. They were not expressing themselves as freely as they had before, she thought. Some mentioned creeping anxieties, when she asked. Others talked about fear.
She wanted to prevent those feelings from dimming the light she saw in each of them, but it was complicated. Self-expression and personal safety could cut brutally against each other for a gay or transgender teen, and a lot of her TaskForce students had bigger worries in any case. They did not always have enough food to eat or safe places to stay; winter was coming and they needed warm coats. “It’s OK,” was sometimes all she could think to tell them. “This is nothing new. We’re just going to keep on jumping these hurdles, one at a time, until we’re free and clear.”
By the start of 2026, Macapagal and her colleagues had settled into an uncertain quiet. The university’s funding had been unfrozen in December and, thanks to a couple of lawsuits, most of the grants that Macapagal’s group had lost were in the process of being restored. But confusion still reigned: When would that money actually be disbursed? Would researchers be given additional time to complete their work? What would happen when those grants came up for renewal in the coming year?
No one seemed to know, but the N.I.H. was still expecting annual progress reports from all its grantees in the meantime. “We are supposed to tell them what we did with the money they gave us and what progress we’ve made in our research,” Alvarado Avila explained. “But they did not really give us the money, and our biggest barrier to progress has been them. How do you say that in a way that’s diplomatic?” The institute where Macapagal worked had 30 fewer staff members now, and lots of empty offices and cubicles. One conference room had become a storage facility for the H.I.V. and S.T.I. test kits that they had originally planned to send to study participants.
“These are supplies that your tax dollars paid for, to get people tested for H.I.V. and S.T.I.s [sexually transmitted infections] in the context of a research study,” Macapagal says. “And now they’re just sitting there and like any medical kit, they will eventually expire.” She was torn about the future, now. On one hand, she could not help but hope. State officials had expressed interest in partnering with her and TaskForce to expand the Prep-4-Teens program, and she had just applied for yet another N.I.H. grant based on the agency’s own stated interest in using implementation science to conquer H.I.V.
On the other hand, though, hope seemed a delusional response to the events of the past year. Word was, new grant applications would ultimately be decided on not by fellow scientists, as had always been the case, but by political appointees who had apparently effectively taken over the N.I.H. Macapagal had spent nearly all of her adult life cultivating expertise in behavioral health and disease prevention, and then training the next generation to do the same. She could not help but wonder now, what the point of any of that had been.
She still wanted to show up for her team. She believed that the work was important and she knew that Alvarado Avila, Buehler and their peers were its future. But truth be told, she was also thinking about going into private practice.
Alvarado Avila was holding off on applying to graduate programs for now, in part because prospects were skimpy for noncitizen scientists who wanted to stay in the United States, but also because he had watched ICE agents descend on Chicago and raid the communities around him. He had also watched them kill an unarmed woman in Minnesota — who was a mother and a poet and a white U.S. citizen, but who also happened to be a lesbian — and his heart was sick and he was angry.
“They say that by focusing on marginalized groups we are discriminating against everyone else,” he said. “But those are the communities most impacted by these issues. They say visa holders like me are stealing jobs from Americans. I don’t think they understand that one, for a specialty visa, you have to prove to the government that you can do the work, and two, we contribute to a tax system that we have no assurance that we will get back from.”
More and more, he wondered what fighting back looked like, and whether it was incompatible with a career that forced you to erase whole categories of people from your work, or treat words like diversity, equity and inclusion as toxins instead of virtues. More and more he wondered if America, where he had lived, studied and worked for most of his life, was still the place for him.
Buehler, for his part, had applied to more than a dozen Ph.D. programs, almost all of them focused on exactly the kind of research he was doing in Macapagal’s lab. “I love this work,” he told me. “I really want to create the kind of programs that I wish I’d had when I was coming up.” He knew the risks, knew that he was probably consigning himself to a path marked by deep uncertainty and that he would find neither glory nor gratitude on the other side of that struggle. But he also knew that perseverance was the key to progress. And the way he saw it, resilience could be an identity, too.
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