A woman walks up to the security guards outside a shuttered USAID-funded sexual health clinic in Johannesburg’s inner-city district.

She looks around with confusion as they let her know the clinic is closed.

She tells us it has only been two months since she came here to receive her usual care.

Now, she must scramble to find another safe place for her sexual health screenings and Pre-Exposure Prophylaxis (PrEP) – her regular defence against rampant HIV.

On the day he was sworn in as US president for a second time, Donald Trump signed an executive order freezing foreign aid for a 90-day period.

That is being challenged by federal employee unions in court over what it says are “unconstitutional and illegal actions” that have created a “global humanitarian crisis”.

However the order is already having an immediate impact on South Africa’s most vulnerable.

Her eyes tear up as she processes the news. Like many sex workers in town, free sexual health clinics are her lifeline.

An HIV-positive sex worker shared her patient transfer letter from the same closed clinic with Sky News and told us with panic that she is still waiting to be registered at an alternative facility.

South Africa is home to one of the world’s worst HIV/AIDS epidemics. At least 8.5 million people here are living with HIV – a quarter of all cases worldwide.

Widespread, free access to antiretroviral treatment in southern Africa was propelled by the introduction of George W. Bush’s US President Emergency Plan for AIDS Relief (PEPFAR) in 2003.

PEPFAR is considered one of the most successful foreign aid programmes in history, and South Africa is the largest recipient of its funds.

The programme has now been halted by President Trump’s foreign aid funding freeze – plunging those who survived South Africa’s HIV epidemic and AIDS denialism in the early 2000s back to a time of scarcity and fear.

“That time, there was no medication. The government would tell us to take beetroot and garlic. It was very difficult for the government to give us treatment but we fought very hard to win this battle. Now, the challenge is that we are going back to the struggle,” says Nelly Zulu, an activist and mother living with HIV in Soweto.

Nelly says access to free treatment has saved her and her 21-year-old son, who tested positive for HIV at four years old.

“It helped me so much because if I didn’t get the treatment, I don’t think I would be alive – even my son.

“My concern is for pregnant women. I don’t want them to go through what I went through – the life I was facing before. I’m scared we will go back to that crisis.”

South African civil society organisations have written a joint open letter calling for their government to provide a coordinated response to address the healthcare emergency created by the US foreign aid freeze.

The letter states that close to a million patients living with HIV have been directly impacted by stop-work orders and that a recent waiver by US Secretary of State Marco Rubio continuing life-saving assistance explicitly excludes “activities that involve abortions, family planning, gender or diversity, equality and inclusion ideology programmes, transgender surgeries or other non-life saving assistance”.

The shuttered clinic we saw in Johannesburg’s central business district (CBD) comes under these categories – built by Witwatersrand University to research reproductive health and cater to vulnerable and marginalised communities.

An activist and healthcare worker at a transgender clinic tells us everyone she knows is utterly afraid.

“Corner to corner, you hear people talking about this. There are people living with chronic diseases who don’t have faith anymore because they don’t know where they are ending up,” says Ambrose, a healthcare worker and activist.

“People keep asking corner to corner – ‘why don’t you go here, why don’t you go there?’ People are crying – they want to be assisted.”

South Africa’s ministry of health insists that only 17% of all HIV/AIDs funding comes from PEPFAR but that statistic is offset by the palpable disruption.

On Monday, minister of health Dr Aaron Motsoaledi met to discuss bilateral health cooperation and new US policy for assistance with US charge d’affaires for South Africa, Dana Brown.

A statement following the meeting says: “Communication channels are open between the Ministry and the Embassy, and we continue to discuss our life-saving health partnership moving forward.

“Until details are available the minister called on all persons on antiretrovirals (ARVs) to under no circumstances stop this life-saving treatment.”

A demand much harder to execute than declare.

“There is already a shortage of the medication – even if you ask for three months’ treatment, they will give you one or two months worth then you have to go back,” says Nelly.

“Now, it is worse because you can see the funding has been cut off.”

One of the victims of the attack on an adult education centre in Sweden rang his fiancee one last time after being shot to tell her he loved her.

Salim Iskef, 29, is thought to be one of the 10 people killed in Orebro on Tuesday.

Local media has named Rickard Andersson as the perpetrator behind the attack, which the Swedish prime minister described as the worst mass shooting in the country’s history.

After being shot, Mr Iskef, a newly engaged nursing assistant, managed to call his fiancee one final time.

“He said he loved me so much”, Kareen Elia, his fiancee, told Sky News’ Swedish partner TV4.

“You have no words. I can’t describe the feelings. We were supposed to get married on July 25,” she said.

She added that, after he called her lying on the floor, she could not understand what she was seeing on FaceTime and was in shock.

Then he said: “Take care of my mother, yourself,” Ms Elia told the Swedish outlet. She added: “He said he had been shot. That they had shot us. I asked where. He hung up. I called again and again but he didn’t answer.”

Ms Elia was critical of the police’s handling of the situation, saying officers could have saved him if they had acted faster.

She also said she was still waiting for confirmation of her fiancee’s death. “We haven’t seen him yet,” she added.

‘We heard him walking around’

It comes as one of the survivors told Sky News correspondent Ashna Hurynag how, as she hid fearing for her life, she heard the footsteps of Andersson close by.

Meracil Kallkvist said: “I was really shaking. It was scary. I was thinking, I was going to panic.

“I wanted to run to save my life because I was thinking I don’t want to get… [hurt] here sitting down and hiding.”

She recounted how she panicked as the first shots rang out, fearing something might have exploded, while some of the other students went to investigate the noises.

Ms Kallkvist said: “They wanted to know, then after like two seconds because [of the] other shots, one person ran back, someone was shooting, so I ran.”

While looking for somewhere to hide, she described how she met her teacher and, unable to lock the door of the room they were in, they pushed tables and chairs against it to try to block it.

It was then they heard Andersson walking around.

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Ms Kallkvist added: “After, we heard him walking around. Yes… it was really scary, if he’d just turned to the room where we were hiding…

“He [was] just walking around and talking and after we heard banging on the doors, I think it was the other room, then suddenly shots again.”

Police previously said they were yet to establish a motive and that the gunman was believed to have shot himself dead.

A British woman has died on holiday in Sri Lanka after a room in her hostel was fumigated for bed bugs, local police said.

Ebony McIntosh, 24, from Derby, was taken to hospital in the capital Colombo on Saturday after becoming ill.

She had reportedly suffered vomiting, nausea and breathing difficulties – but died there hours later.

Another woman Nadie Raguse, 26, from Germany, who was also staying at the Miracle Colombo City Hostel died, Sri Lanka police said.

The force’s spokesperson Buddhika Manatunga said a room in the hostel had been fumigated for bed bugs before the women fell ill – and that they are investigating the possibility of poisoning by noxious pesticides.

The hostel is closed until further notice.

The digital marketing and social media manager’s family has set up a GoFundMe page to help with the cost of returning her body to the UK.

‘Absolutely heartbroken’

A statement on the page read: “We are absolutely heartbroken to share that our beautiful baby girl and big sister Ebony has passed away unexpectedly on Saturday 1st February 2025, thousands of miles away from home.

“Words cannot begin to express how broken we are, it’s been like a nightmare since we found out on Sunday morning, we have prayed and prayed that this can’t be true. It couldn’t possibly happen to our lovely Ebs.”

The statement added: “We cannot even begin to imagine how scared she must have felt at the time and it hurts us so badly to think of the pain she was in. We need to be with her and bring her home safely.

“She passed away with someone from the hostel beside her. We are endlessly grateful to this man for staying with her during her last moments.”

The family said Ms McIntosh had started her holiday on 28 January when she flew from Heathrow to “follow her dreams of travelling all over South Asia, starting in Sri Lanka”.

They said she was “full of excitement for her adventures ahead, in typical Ebony style she had spent months researching and planning and drawing up schedules for the coming months”.

“Her trip was cruelly cut short on Saturday 1st February, when she [was taken] very ill in the hostel she was staying in.”

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A cause of death has not been established – and a post-mortem examination cannot take place until the family arrives on 10 February, the police said.

A Foreign, Commonwealth & Development Office (FCDO) spokesperson confirmed: “We are supporting the family of a British woman who died in Sri Lanka, and are in contact with the local authorities.”