A landmark breakthrough in HIV prevention — a scientific feat decades in the making — received final approval from the Food and Drug Administration last month. Gilead Sciences’ lenacapavir is so effective that global health leaders had started to cautiously talk about the end of an epidemic that continues to kill more than 600,000 people each year.

We should be celebrating its arrival.

Instead, aid groups and the countries most affected by HIV are reeling from the Trump administration’s relentless attacks on the global health infrastructure. Instead of perfecting plans for a rollout of the medication, they are scrambling to ensure people with HIV have the drugs they need to survive.

Last year, I wrote about the stunning — or as one HIV expert described it, “spine-chilling”— results from a large study of lenacapavir. None of the women and adolescents who were given the twice-yearly injection in the trial became infected with HIV. In a second study involving men who have sex with men, and transgender individuals who have sex with men, the treatment was 96% effective. Even better, Gilead is working on a newer version that could potentially offer protection for a year or more.

That’s about as close to an HIV vaccine we’re likely to get — at least for many years. It’s also the world’s best shot of achieving the goal of ending HIV by 2030.

For low- and middle-income countries that continue to face frustratingly stubborn infection rates, a twice-yearly drug could be a game-changer. Although existing treatments of daily pills do an excellent job at preventing infection, getting people to use them consistently has been difficult.

There is the stigma attached to the pills. Ensuring patients return for frequent testing and refills is also challenging — as is simply remembering to take them daily. Consider the typical day of a mom with a newborn and it’s easy to understand how six months of protection could make a real difference in lowering HIV cases in women and infants.

Some experts have even suggested lenacapavir is our best chance of wiping out new infections in children.

That was before the Trump administration abruptly shut down USAID, the lead agency behind Pepfar. The global initiative to combat HIV/AIDS is credited with saving an estimated 26 million lives since its inception in 2003. Although the administration granted a limited waiver to allow some HIV services to continue, funding is significantly restrained.

As health workers grapple with fewer resources, their focus has shifted to people living with HIV. “When the chips are down, you safeguard treatment because those people will die if they don’t get their antiretroviral,” says Linda-Gail Bekker, director of the Desmund Tutu HIV Centre at the University of Cape Town. And yet, she said, “prevention we know is an absolute cornerstone to bringing this epidemic under control.”

Because the situation is so dynamic, it’s been difficult to capture what’s happening on the ground. The best current model suggests the administration’s actions could result in at least 70,000 additional new infections, and another 5,000 deaths in the next five years.

UCLA infectious disease epidemiologist Dvora Joseph Davey says that in 2024, the eight public health clinics in Cape Town — where she is based — saw three infants who were HIV-positive at birth. In the first five months of this year, they’ve already seen three babies born with the infection.

She knows there will be more. One pregnant woman with HIV recently came into the clinic and, at 37 weeks, her viral load was dauntingly high. She’d skipped picking up her last three-month supply of pills. The nurse she’d been seeing was let go as part of the funding cuts, and no one was available to do a blood draw at her last visit, Davey says.

If the people who, in theory, should still be benefiting from global aid are falling through the cracks, what hope do we have for prevention?

Prevention efforts have already been severely disrupted in some countries. Supply is responsible for some of the upheaval, but the more complicated problem is getting the drugs to the people who need them most. “We need low-cost product and also a low-cost delivery mode,” says Carmen Pérez Casas, senior strategy lead at Unitaid, a global health initiative hosted by the World Health Organization. The situation for the latter “has changed radically,” she says.

HIV prevention is not as simple as just handing out a prescription. It’s first identifying those most at risk of infection, getting them tested to confirm they are negative, and offering counseling about their options. It’s ensuring they return for more testing and the next dose of their medication. That requires a vast support network ranging from doctors and nurses to counselors, pharmacists, lab technicians, data scientists and more.

Pepfar supported all of that infrastructure. In South Africa, for example, cuts have resulted in lost jobs for some 8,000 health workers focused on HIV.

Aid groups are doing their best to ensure the breakthrough’s promise is not entirely lost. Their first hurdle is bridging the gap to the arrival of low-cost generic lenacapavir, which isn’t expected until sometime in 2027. (Gilead is allowing a handful of drug companies to make and sell generic forms of lenacapavir in the countries most heavily impacted by HIV.) Global health agencies are anxiously awaiting the company’s price tag for those countries to understand how far their funding can be stretched.

Then they need to get the drug to patients. Experts tell me they’ve scaled back their expectations given the upheaval with Pepfar. The Trump administration’s termination of National Institutes of Health grants to foreign countries has created additional hurdles. It’s been particularly devastating in South Africa, where the NIH supported a significant chunk of research related to HIV. That means less money to conduct so-called implementation studies for lenacapavir, which are crucial for understanding how to improve the drug’s use in the real world. One simple thing the Trump administration could do is free up funding for prevention. Pepfar continues to operate under a waiver that only allows PrEP money to be spent for those who are pregnant or breastfeeding.

Groundbreaking science alone won’t end HIV. It must be paired with affordability and access. The Trump administration’s callous cuts to global health efforts put all of those things at risk — including the promising future where HIV is brought to heel.

Lisa Jarvis is a Bloomberg Opinion columnist covering biotech, health care and the pharmaceutical industry. Previously, she was executive editor of Chemical & Engineering News.

WASHINGTON — It was a Jack Nicholson-Tom Cruise moment. President Donald Trump couldn’t handle the truth. He didn’t even know the truth. And he has no respect for truth, so even if he knew, why would he tell the truth about the truth?

At a White House lunch with African leaders on Wednesday, Trump engaged in a bizarre exchange with the New York Times White House reporter Shawn McCreesh.

The day before, when CNN’s Kaitlan Collins asked the president who authorized the pause on weapons shipments to Ukraine — at a time when Russia is engaged in a barbarous onslaught, indiscriminately killing civilians — Trump replied, defensively: “I don’t know. Why don’t you tell me?”

The Pentagon’s puer aeternus, Pete Hegseth, was sitting right beside Trump. And reporters soon ferreted out the information that perennial screw-up Hegseth had ordered the pause without telling Trump, Marco Rubio and other top officials.

Trump reversed the Pentagon chief, reflecting a belated awareness of the fact that Vladimir Putin is playing him for a fool. Like a spurned lover, he keened that his Russian boyfriend’s promises are “meaningless.”

In a follow-up the next day, McCreesh asked Trump if he had figured out who had ordered the munitions to Ukraine halted.

When Trump said no, McCreesh pressed him: “What does it say that such a big decision could be made inside your government without your knowing?”

Trump bristled. A jester like Hegseth had kept the king in the dark on a consequential move.

“If a decision was made, I will know,” Trump blustered. “I’ll be the first to know. In fact, most likely I’d give the order, but I haven’t done that yet.”

It is not reassuring, at a time of man-made and natural disasters, that the president is spouting gobbledygook and his maladroit Cabinet members are spinning out.

It’s a paradox: If you choose your Cabinet based on looks, you are likely to end up with a Cabinet that makes you look bad. Running government is harder than bloviating on Fox News and assorted podcasts.

And if you demand über-fealty from your advisers, you will end up surrounded by toadies who don’t level with you.

In the dishy new book “2024: How Trump Retook the White House and the Democrats Lost America,” Josh Dawsey, Tyler Pager and Isaac Arnsdorf describe how Sergio Gor, a Trump aide who rose by publishing Trump’s coffee table books, created draconian loyalty tests during the transition.

“Trump believed the biggest mistake of his first term was picking disloyal officials, and Gor was determined to disqualify candidates who had ever criticized Trump or anyone associated with him,” the authors write.

Kristi Noem is loyal to Trump. But perhaps it was too much to ask that someone who executed her own puppy was going to understand the humanitarian necessity of the Federal Emergency Management Agency.

Noem has been parroting Trump and talking about abolishing FEMA since she got the job heading the Department of Homeland Security. She recently enacted a debilitating rule designed to cut the FEMA budget, dictating that every grant and contract over $100,000 needs explicit permission from her.

As CNN pointed out, that’s “pennies” in an agency where disaster costs soar into the billions. At the same time, The Times reports, the agency didn’t answer nearly two-thirds of calls to its disaster line because it had fired hundreds of call center contractors. (Now, confronted with the Texas disaster, the administration is backing off the eradication plan.)

As Trump was preparing to travel to Kerr County, Texas, to inspect flood damage on Friday, the White House posted a meme of him as Superman, playing off the new movie about the Man of Steel. But the initial federal response was less than super. Noem didn’t authorize FEMA’s deployment of rescue teams until Monday, more than 72 hours after the flooding began, CNN reported, and there have been questions about crucial staffing shortages at the National Weather Service as floodwaters rose.

Pam Bondi enraged the Trump faithful when, after she inflamed conspiracy theorists about Jeffrey Epstein documents, her DOJ said Monday there was nothing more to see. No client list. Move along, please. “Are people still talking about this guy, this creep?” an irritated Trump asked reporters about his erstwhile pedophile playmate.

Laura Loomer demanded that Bondi resign, writing on X: “I cannot sugar coat how much good will Pam Blondi has cost the Trump admin with the base this week. She is a massive liability to President Trump.”

On Wednesday, Bondi angrily accused Dan Bongino, conspiracist podcaster turned FBI deputy director, of leaking stories that whipped up expectations for Epstein secrets. He denied it, and told people he was considering quitting.

Now furious right-wing conspiracists think there’s a cover-up of the cover-up.

Vapidly, Agriculture Secretary Brooke Rollins suggested people on Medicaid could replace deported immigrants. They can pick our crops! It’s unreal, but Sean Duffy, once a “Real World” cast member, is in charge of transportation and NASA. And don’t forget the scary spike in measles cases fueled by the anti-vaccine crowd; thank you, RFK Jr.!

It turns out, even good-looking dodos are still dodos.

Maureen Dowd writes a column for the New York Times.

SAN DIEGO (AP) — U.S. Immigration and Customs Enforcement has moved to detain far more people than before by tapping a legal authority to jail anyone who entered the country illegally without allowing them a bond hearing.

Todd Lyons, ICE’s acting director, wrote employees on July 8 that the agency was revisiting its “extraordinarily broad and equally complex” authority to detain people and that, effective immediately, people would be ineligible for a bond hearing before an immigration judge. Instead, they cannot be released unless the Homeland Security Department makes an exception.

The directive, first reported by The Washington Post, signals wider use of a 1996 law to detain people who had previously been allowed to remain free while their cases wind through immigration court.

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Asked Tuesday to comment on the memo, a copy of which was obtained by The Associated Press, Homeland Security spokesperson Tricia McLaughlin said, “The Biden administration dangerously unleashed millions of unvetted illegal aliens into the country — and they used many loopholes to do so. President (Donald) Trump and Secretary (Kristi) Noem are now enforcing this law as it was actually written to keep America safe.”

McLaughlin said ICE will have “plenty of bed space” after Trump signed a law that spends about $170 billion on border and immigration enforcement. It puts ICE on the cusp of staggering growth, infusing it with $76.5 billion over five years, or nearly 10 times its current annual budget. That includes $45 billion for detention.

Greg Chen, senior director of government relations at the American Immigration Lawyers Association, began hearing from lawyers across the country last week that clients were being taken into custody in immigration court under the new directive. One person who was detained lived in the United States for 25 years.

While it won’t affect people who came legally and overstayed their visas, the initiative would apply to anyone who crossed the border illegally, Chen said.

The Trump administration “has acted with lightning speed to ramp up massive detention policy to detain as many people as possible now without any individualized review done by a judge. This is going to turn the United States into a nation that imprisons people as a matter of course,” Chen said.

Matt Adams, legal director of the Northwest Immigrant Rights Project, said the administration is “adopting a draconian interpretation of the statute” to jail people who may have lived in the U.S. for decades, have no criminal history and have U.S. citizen spouses, children and grandchildren. His organization sued the administration in March over what it said was a growing practice among immigration judges in Tacoma, Washington, to jail people for prolonged, mandatory periods.

Lyons wrote in his memo that detention was entirely within ICE’s discretion, but he acknowledged a legal challenge was likely. For that reason, he told ICE attorneys to continue gathering evidence to argue for detention before an immigration judge, including potential danger to the community and flight risk.

ICE held about 56,000 people at the end of June, near an all-time high and above its budgeted capacity of about 41,000. Homeland Security said new funding will allow for an average daily population of 100,000 people.

In January, Trump signed the Laken Riley Act, named for a slain Georgia nursing student, which required detention for people in the country illegally who are arrested or charged with relatively minor crimes, including burglary, theft and shoplifting, in addition to violent crimes.

LOS ANGELES (AP) — An American Idol music supervisor and husband were both found dead in their Los Angeles home Monday afternoon.

Officers were conducting a welfare check at a home in the Encino neighborhood when they found the bodies of a man and woman with gunshot wounds.

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An American Idol spokesperson confirmed the deaths of Robin Kaye and her husband, Thomas Deluca, both 70. The couple owned their home, according to public records.

Los Angeles police say they are investigating their deaths as homicides but have not identified any suspects.

“Robin has been a cornerstone of the Idol family since 2009 and was truly loved and respected by all who came in contact with her,” an American Idol spokesperson said in a statement. “Robin will remain in our hearts forever and we share our deepest sympathy with her family and friends during this difficult time.”

Kaye, an industry veteran, has also worked in the music departments of several other productions such as “The Singing Bee,” “Hollywood Game Night,” “Lip Sync Battle,” and several Miss USA and Miss Universe pageants.