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.
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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.
Image: A sign for USAID on the clinic’s window
Image: A shuttered USAID-funded sexual health clinic in Johannesburg
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.”
Image: Nelly Zulu, an activist and mother living with HIV
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.
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3:48
USAID in turmoil: What you need to know
“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.”
Emmanuel Macron has said Russia is reinterpreting what was agreed in the Black Sea ceasefire talks – as he met with Ukraine President Volodymyr Zelenskyy at the Elysee Palace in Paris.
Ukraine and Russia agreed to a tentative ceasefire brokered by the US involving the Black Sea and strikes on energy infrastructure on Tuesday.
But drone strikes were reported just hours after the US reached the deals separately with each country, with the mayor of the Ukrainian port city Mykolaiv saying there were emergency power outages after reports seven drones were downed over the region.
“I note today Russia is always tempted to reinterpret what we discuss and agree,” the French president said on Wednesday.
“While saying it wants peace, Russia continues to strike intensely the Ukrainian territory, including civilian targets. These strikes – we condemn them.”
Image: Emmanuel Macron and Volodymyr Zelenskyy hug as they meet ahead of a peace and security conference in Paris. Pic: Reuters
Image: Pic: Reuters
Image: Pic: Reuters
Secretary of state Marco Rubio said on Wednesday that the US will evaluate demands made by Russia after Moscow agreed “in principle” to the ceasefire.
Russia also accused Ukraine of targeting energy infrastructure in Crimea, Kursk and Bryansk but this has not been independently verified. Ukraine denied the claims.
Meanwhile, Russia launched its largest drone attack yet on Mr Zelenskyy’s hometown of Kryvyi Rih, according to the city’s military administration chief.
Macron announces further military support
As Mr Macron announced an additional $2bn of military support for Ukraine, he added that Russia cannot dictate the conditions for a lasting peace in Ukraine.
When questioned on whether sanctions on Russia should be lifted, Mr Macron said it is “much too early”.
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2:45
Black Sea ceasefire: Who benefits?
The French president also said that a proposed European armed force for possible deployment in Ukraine in tandem with an eventual peace deal could “respond” to a Russian attack if Moscow launched one.
At a news conference after the meeting of the two leaders, Mr Zelenskyy said that he expects the US will be able to ensure Vladimir Putin accepts a ceasefire.
“We believe America will be strong enough to lead Putin to accept an unconditional ceasefire,” he said.
President Zelenskyy’s trip to Paris comes ahead of a summit of European leaders on Ukraine and security on Thursday.
The so-called “coalition of the willing” nations that are allies of Ukraine will discuss options for a peacekeeping solution for the country after the war ends, with France and Britain leading efforts.
Meanwhile, Mr Zelenskyy’s chief of staff said on Wednesday that US-Ukraine ties were “back on track”.
In an interview with Reuters news agency, Andriy Yermak said two rounds of talks in Saudi Arabia gave Kyiv the chance to show US officials it is open to working with Donald Trump to end the war.
“I think we have great conversations with the Americans. I think we are back on track,” he said.
Defence minister Rustem Umerov said Ukraine had agreed to “ensure safe navigation, eliminate the use of force, and prevent the use of commercial vessels for military purposes”.
However, Russia claimed it depended on Western sanctions being lifted on fertiliser and food companies and ensuring its access to the SWIFT payments system.
President Zelenskyy said he believed the truce was effective immediately and accused Moscow of playing games.
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“Unfortunately, even now, even today, on the very day of negotiations, we see how the Russians have already begun to manipulate,” he said.
“They are already trying to distort agreements and, in fact, deceive both our intermediaries and the entire world.”
Image: Mr Zelenskyy said Russia was already manipulating over the deal. Pic: Reuters
A White House statement said the US would help “restore Russia’s access to the world market for agricultural and fertiliser exports”.
President Trump said his administration was “looking into” Russia’s request to lift sanctions.
A senior official in the Ukrainian government, speaking anonymously to the AP news agency, said Kyiv did not agree to lifting sanctions as a condition for a maritime ceasefire.
They said Russia had done nothing to have sanctions reversed.
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0:46
Child killed in Russian drone strike on Kyiv
While uncertainty remains over the terms of the Black Sea truce, the Kremlin confirmed it would honour a ceasefire on attacking energy facilities until 17 April.
It said oil refineries, pipelines, power plants and substations, nuclear power plants and hydroelectric dams were all covered by the deal.
It added: “In the event of a violation of the moratorium by one of the parties, the other party has the right to consider itself free from obligations to comply with it.”
Sky News security analyst Michael Clarke said the Black Sea deal was something the US “can boast about” but won’t massively change anything on the ground in Ukraine.
“The Russians will be quite happy about that because they’ll just keep going down more and more rabbit holes,” he said.
“Unless the Americans are prepared to pressure Russia as opposed to just keeping offering them more advantages, the war will just go on,” added Professor Clarke.
Earlier in March, President Zelenskyy said he was ready for a 30-day ceasefire that would also include “the entire front line”.
American secretary of state Marco Rubio said the ball was “in Russia’s court” but President Putin has declined to follow suit and named multiple pre-conditions.
Donald Trump has been urged to fire US Secretary of Defence Pete Hegseth following the leak of highly sensitive war plans – as national security adviser Mike Waltz said he took “full responsibility” for organising the group chat.
The conversation on the messaging app Signal between US officials, including vice presidentJD Vance and Mr Hegseth, was leaked to American journalist Jeffrey Goldberg, who was added to the chat in error.
Mr Waltz –who had mistakenly added Mr Goldberg to the Signal discussion – said: “I take full responsibility…I built the group.”
Democratic congressman Hakeem Jeffries, minority leader of the US House of Representatives, described Mr Hegseth as “the most unqualified Secretary of Defence in American history” and called for him to be sacked.
“His continued presence in the top position of leadership at the Pentagon threatens the nation’s security and puts our brave men and women in uniform throughout the world in danger,” he wrote.
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“His behaviour shocks the conscience, risked American lives and likely violated the law.
“Secretary of Defence Pete Hegseth should be fired immediately.”
Image: The president has defended national security adviser Mike Waltz. Pic: Reuters
Speaking from the White House, Mr Trump downplayed the incident and said he believed the chat contained “no classified information”.
“They were using an app, as I understand it, that a lot of people in government use, a lot of people in the media use,” he told reporters.
Trump expressed support for Mr Waltz, telling NBC News his national security adviser “has learned a lesson, and he’s a good man”.
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7:40
How serious is US chat breach?
The US president said officials would “probably” not use Signal any longer but did not agree to a full investigation of what Democrats have called a major security breach which required high-level resignations.
Included in the conversation on Signal were Mr Vance, Secretary of State Marco Rubio and Mr Hegseth.
Director of National Intelligence Tulsi Gabbard and CIA director John Ratcliffe – who were both also in the chat – testified before the Senate Intelligence Committee on Tuesday that no classified material was shared.
Image: Tulsi Gabbard and John Ratcliffe were under pressure as the Senate Intelligence Committee challenged them about the leak. Pic: Reuters
But Democratic senators have voiced scepticism, noting that the journalist, The Atlantic editor-in-chief Jeffrey Goldberg, reported Mr Hegseth posted operational details “including information about targets, weapons the US would be deploying, and attack sequencing”.
Republican majority leader, John Thune, said on Tuesday he expected the Senate Armed Services Committee to look into Trump administration officials’ use of Signal.
Meanwhile, the White House has mostly attacked the journalist responsible for the original story instead of admitting culpability. The integrity of Mr Goldberg has been repeatedly called into question.
Posting on X, White House press secretary Karoline Leavitt accused Mr Goldberg of sensationalising the story, and White House communications director Steven Cheung called the media coverage of the security breach a “witch hunt”.
If a British defence minister was found to have shared details about a live military operation in an unofficial messaging group with colleagues, they would be sacked.
That President Donald Trump has tried to dismiss the revelation that his top defence and security team not only did just that but accidentally included a journalist in the chat will be watched with deepening horror by US allies and growing glee by American enemies.
In public, the UK government is still insisting security ties with the US are as strong as ever.
But in private there will doubtless be horror – though perhaps not surprise – within Whitehall at this extraordinary lapse in the most basic operational security by the president’s national security adviser, defence secretary, national intelligence chief and even the boss of the CIA.
Any information about plans to – for example – launch bombing raids against Iranian-backed Houthi militants in Yemen would ordinarily only be shared on specially designated government systems that ensure classified information is secure.
The fact that Mike Waltz, the national security adviser, felt it was acceptable to set up a group on the commercial messaging app Signal – which does provide encryption but is only as secure as the device that it is being used on (so not secure at all if a mobile phone or laptop is compromised) – to discuss plans to attack the Houthis is bad enough.
The Atlantic has hit back, dismissing those claims. “Attempts to disparage and discredit The Atlantic, our editor, and our reporting follow an obvious playbook by elected officials and others in power who are hostile to journalists and the First Amendment rights of all Americans,” it said in a statement.
Mr Hegseth told reporters on Monday no one had texted war plans – prompting Mr Goldberg to call those comments a lie during an interview on CNN.
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It remains unclear why the officials chose to chat via Signal instead of secure government channels typically used for sensitive discussions.
The Pentagon reportedly warned of a known vulnerability on the Signal chat app, in an email sent out prior to the publication of The Atlantic article, according to reports by Sky News’ US partner network NBC News.
The email reported: “Russia-aligned threat groups are actively targeting the Signal Messenger application of individuals likely to exchange sensitive military and government communications related to the war in Ukraine”.
Employees were told the vulnerability could be mitigated by updating to the latest version of the app and applying proper settings.