2026-04-25 19:15:00
2016年11月28日，马萨诸塞州阿默斯特市汉普郡学院（Hampshire College）图书馆外的学生。| Joanne Rathe/The Boston Globe via Getty Images
美国高等教育正面临危机。上周，位于马萨诸塞州阿默斯特市的私立文理学院汉普郡学院宣布将在2026年秋季学期后关闭。该学院成立于1965年，旨在“重新定义文理教育”，其知名校友包括纪录片导演肯·伯恩斯（Ken Burns）和演员卢皮塔·尼永奥（Lupita Nyong’o）、利夫·施里伯（Liev Schreiber）。然而，汉普郡学院只是美国高等教育危机的一个缩影。美国共有约4000所大学，自新冠疫情以来已有约100所关闭，未来十年还可能有更多面临关闭风险。目前，大型公立大学和资金充足的私立名校如哈佛、耶鲁等仍相对稳定，但小型区域学院则面临更大压力。这种趋势可能导致学生选择高等教育的选项减少，甚至彻底关闭大门。
为了解为何学院会关闭以及这对美国高等教育的未来意味着什么，Today, Explained节目主持人兼合作者塞安·拉梅萨拉姆（Sean Rameswaram）采访了《Hechinger报告》的高级高等教育记者乔恩·马库斯（Jon Marcus）。马库斯解释了汉普郡学院的困境，以及影响学院的财务、人口和文化因素。以下是对话摘录（已删减并精简）：
汉普郡学院的关闭并非偶然。像许多小型学院一样，它长期面临隐性问题。该学院的问题早在疫情前就已显现，但依靠忠诚且成功的校友群体维持运营。然而，其基金规模较小，学生人数持续下降，最终仅剩不到800名学生，且背负2100万美元债务。债务是关键因素之一，常被忽视。人们通常只关注学生贷款债务，但学院本身也面临巨额债务，这会严重消耗其运营预算。为了吸引学生，学院普遍采取学费折扣政策，整体折扣率超过50%。对于私立学院而言，这相当于将一半收入返还给学生，长期来看难以维持。
自疫情以来，已有约100所学院关闭，其中许多依赖联邦援助才得以维持。若无援助，它们可能更早倒闭。最新估计显示，美国有442所私立非营利学院面临关闭风险，其中约120所处于严重风险中。造成关闭的原因包括学生人数减少、人口结构变化（18岁年轻人数量下降）以及高昂的教育成本。此外，特朗普政府对国际学生的政策收紧也对小型学院造成冲击，因为国际学生通常支付全额学费，是其重要收入来源。过去一年，国际学生签证发放量下降了36%。
当学生得知学院即将关闭时，通常面临严峻后果。研究显示，一半学生会转学，但其中一半最终未能完成学业。转学后，许多学院不接受原有学分，导致学生难以继续学业。此外，这些小型学院往往位于偏远地区，吸引年轻人定居并推动当地经济发展。随着学院关闭，这些地区的人口老龄化问题加剧，经济多元化管道也随之中断。
尽管有人认为“汉普郡学院关闭与我无关”，但若大量小型学院关闭，美国小城镇和城市将面临“死亡螺旋”效应。人们在社交媒体上对学院关闭的反应往往带有敌意，认为其过于精英化、政治正确或过于左倾。尽管这种看法未必准确，但学院未能有效应对这种负面舆论。然而，这些小型文理学院在培养具备特定技能的年轻人才方面仍至关重要，它们的消失将削弱美国的教育竞争力。
Higher education is in crisis. Last week, Hampshire College — a private liberal arts school in Amherst, Massachusetts — announced it will shut down after the fall 2026 semester.
Founded in 1965 to “reimagine liberal arts education,” Hampshire counts documentary filmmaker Ken Burns and actors Lupita Nyong’o and Liev Schreiber among its most notable alumni.
But Hampshire is just the latest casualty in a broader trend. There are roughly 4,000 colleges in the United States. According to Jon Marcus, senior higher education reporter at the Hechinger Report, a nonprofit publication covering education, around 100 have closed since the Covid-19 pandemic, and many more are at risk over the next decade.
For now, large public universities and well-endowed private schools like Harvard and Yale remain relatively stable. But smaller regional colleges are increasingly at risk. That shift could leave students with fewer options for higher education, and,, for some, close the door on higher education entirely.
To understand why colleges are closing and what it means for the future of higher education in the United States, Today, Explained co-host Sean Rameswaram spoke with Marcus, who explained the story of Hampshire College and some of the financial, demographic, and cultural elements afflicting colleges.
Below is an excerpt of the conversation, edited for length and clarity. There’s much more in the full podcast, so listen to Today, Explained wherever you get podcasts, including Apple Podcasts, Pandora, and Spotify.
Last week it was announced that the private liberal arts college Hampshire College would close after its fall semester. Tell us the story of what happened to Hampshire.
Like a lot of small colleges, Hampshire had a lot of problems hidden just below the surface. In Hampshire’s case, they weren’t that well-hidden. It had been having problems for more than six years, since before the pandemic, but was being kept afloat by its very loyal alumni, who include some people that have been extremely successful, largely in the arts.
Its endowment was very small. Its enrollment continued to decline. It had fewer than 800 students left at the end. It had $21 million in debt.
Debt is a really important and largely misunderstood component of this. When people think of debt and college, they think of student loan debt, but there’s also institutional debt, and it is really piling up. Colleges and universities have borrowed significant amounts of money and, so, servicing that debt becomes a big drain on their operating budgets. To attract students, colleges do something else that isn’t widely known: They discount the tuition. Almost no one pays the list price you see on the website.
At Hampshire, specifically, or everywhere?
At colleges in general. The discount rate at colleges and universities is more than 50 percent. So, if you were a private business, and you gave back 50 percent of your revenue, you’d be out of business. And that’s what’s happening to a lot of these small colleges.
At Hampshire, they were giving back more than 75 percent of their revenue in the form of discounts just to continue to get people to come there and fill seats.
It sounds like this is happening far more often than we know — that four-year colleges and universities are going out of business.
About a hundred colleges have closed since the pandemic. Many of them only made it this far because they got federal aid during the pandemic to keep them open. Had they not, they would’ve probably closed sooner. And there’s a new estimate that shows that 442 private nonprofit colleges and universities — that’s one quarter of the total — are at risk. About 120 of them are at severe risk of closing.
What are the other causes for college closures?
We are running out of students. The number of 18-year-olds is way down. People stop having children during financial downturns. And if you do the math, the great recession was in 2008. So, in 2026 is when that hits us.
Eighteen years later, we’re running out of 18-year-olds, and that will begin to have an impact on college enrollment in the fall. The last big class was the one that enrolled in this most recent fall. The next fall is when the demographic cliff begins to hit.
And it’s just math. We have too many colleges, and we have too few traditional-age college students. Of the ones we still have, a smaller proportion of graduates from high school are choosing to go to college.
We hit a peak in 2016 of 70 percent of high school graduates going to college. That’s now down to just a little bit better than 60 percent. That is a big, big drop in a very short time. And that has to do with the cost of higher education and the growing skepticism about the return on the investment. So, that’s really taking a toll.
There is the demographic cliff and cost. There’s also a culture war around our colleges and universities currently being waged by [the Trump] administration. Does that have something to do with it?
That is not helping. Under this current presidential administration, we are seeing a lot of other impacts on higher ed[ucation] obscuring the reality of what’s going on. The sustainability of higher education has been the focus that we’ve all understandably had on this firehose of funding cuts and lawsuits and attacks on DEI [Diversity, Equity, and Inclusion].
In the end, though, the kinds of colleges that we’re talking about that are at risk of closing, this doesn’t affect them, because they don’t do federally funded research. The one policy under this administration that is hurting some of these small colleges is the crackdown on international students.
Some of these small colleges have recruited international students, because they’re profitable. They pay the full tuition. And so, we’ve seen now a 36 percent decline last year in the number of visas issued for new international students. That’s a giant hit.
Essentially, it’s just a perfect storm of all of these things happening at the same time to colleges that are already overextended, overly indebted, and don’t have enough students.
What happens to a student who goes to one of these schools when they find out their school is closing?
Nothing good happens to those students. There is research that shows that half of those students transfer, half of them don’t. Half of them end their pursuit of a degree. Of the half that transfer, half of them never graduate.
The reasons for that include the cost and the fact that the successor college often doesn’t take all of their credits or won’t accept their transfer credits toward the major. And, in many cases, students have left these small colleges that have closed; gone to another college; and then, it closed.
This is becoming a cycle. And one really fascinating thing that I started hearing a few years ago from a student tour guide at a small college was that parents were beginning to ask a question he never heard. And it wasn’t, “How’s the food?” It was, “Will this college still be here in four years?” So, people are beginning to pay attention.
To some degree, you’re speaking about market forces. There’s not enough students, the costs are too high, so the market’s correcting and these schools are closing. But what do we lose when we lose these smaller regional liberal arts colleges?
The first and most important thing is: Not everyone needs to go to college, but somebody needs to go to college. And college-going in the United States is down. In economic rival countries globally, college-going is way up. So, we’re losing the competitive edge that we’ve always had by having a well-educated, innovative, and entrepreneurial population. That’s the big picture.
The small picture is more immediate. As you might assume, a college that closes is a problem for its community, because you lose jobs. Housing values go down when you lose a major employer.
But here’s the one that surprised me that I never really thought about: A lot of these colleges are in remote, isolated places, often rural, and they draw young people to these communities. After they graduate, they stay, and they create businesses, or they work in jobs. And a lot of the colleges that have closed, they’re in places where the population is aging. All of these colleges that have closed are another kind of ending of the pipeline that was bringing in young people to a place where they were needed to diversify the economy.
For someone out there who’s like, “Hampshire College, never heard of her, doesn’t affect me,” what they might be missing is that if enough of these schools close, you’re going to see a bit of a death spiral, a doom loop, in smaller American cities.
Yes; I would say more small towns than cities. But even in some cities where colleges close, again, it’s a lot of payroll. There’s a lot of employees. There’s the add-on spending of the students who buy pizza or rent apartments. But ,to your point, the immediate reaction I’ve noticed on social media and elsewhere is, “Good, let ’em close.”
There’s a real antipathy toward colleges among some people in the public who feel that they are elitist, that they are woke, that they’re overly liberal, that they’re indoctrinating young people.
Whether that’s true or not, that’s the public perception, and I don’t think colleges have done a very good job at counteracting that narrative. But they’re also really important. We need them. We need them in some form to continue to educate young people for jobs that require those skills.
2026-04-25 18:30:00
杰弗里·爱泼斯坦（Jeffrey Epstein）并非第一个利用慈善事业来讨好权贵的富豪。尽管爱泼斯坦因性犯罪被定罪，但许多机构仍接受他的捐款，导致严重声誉损害。例如，麻省理工学院媒体实验室、帕尔梅拉斯芭蕾舞团等组织都曾接受他的资助。比尔·盖茨也曾与爱泼斯坦合作，但后来多次为此道歉。然而，即便在爱泼斯坦案后，大多数慈善机构仍未建立应对有毒捐赠者的明确政策。
文章指出，一些富豪通过捐赠来洗白自身形象，如萨克勒家族（OxyContin制造商）和沃伦·坎德斯（曾因制造催泪瓦斯被谴责）。心理学家认为，这种行为可能使捐赠者产生“道德许可”心理，即通过善举获得做坏事的借口。例如，爱泼斯坦的捐赠者可能认为，只要资金用于公益，便可忽视其过往罪行。
2023年的一项调查显示，超过半数的筹款人认为近年来有毒捐赠者的数量增加，但仅三分之一的机构有明确处理政策。公众对接受此类捐赠的态度也存在分歧，尽管多数人容忍种族主义或白领犯罪，但若资金直接来自犯罪所得，则持反对意见。此外，接受有争议捐赠者可能损害机构声誉，甚至影响未来筹款。
历史上，许多争议性捐赠者也曾获得支持，如安德鲁·卡内基（尽管其财富来自剥削劳工）和约翰·D·洛克菲勒（因开发奥施曼药物引发争议）。这些案例表明，尽管存在道德争议，但机构仍可能接受捐赠。然而，随着社会对透明度和道德责任的要求提高，组织需更加谨慎，避免与有争议的捐赠者合作，以免损害自身声誉。文章最后建议，若无法向公众解释某笔捐赠的合理性，应拒绝接受，以免“与魔鬼做交易”。
Not everybody acquiesced when Jeffrey Epstein came bearing gifts.
Harvard University barred Epstein’s donations after he pleaded guilty to solicitation of a minor in 2008, a development that frustrated his friends on the faculty, according to an internal review. One physicist, a woman whom Epstein had bragged about and racially misprofiled in an interview that Science published after his death, had pointedly refused a donation just months before his second arrest in 2019. “Would I be interested in receiving funding from a wealthy man who had also been convicted of a sex offense?” she told Science. The answer was no.
But others, many others, said yes when Epstein came calling. Among them: the Palm Beach Ballet, the Melanoma Research Alliance, the UJA-Federation of New York, and MIT Media Lab. Bill Gates once legitimized such giving, evangelizing to other would-be billionaire philanthropists over brunch at the convicted sex criminal’s mansion. Gates has since repeatedly apologized for his dealings with Epstein, but the multi-billionaire’s foundation has authorized an external review examining Gates’s ties and assessing their philanthropic vetting policies.
In recent years, the Epstein files have triggered mass public dismay over the idea that a sex criminal could buy — or, in these cases, donate — his way into elite circles. And yet today, over a decade after most of these checks were cashed, not much has changed about how organizations behave when bad people try to give to good causes. By using his giving to ingratiate himself with the rich and famous, Epstein may have embodied philanthropy at its absolute worst, most craven, and self-serving. But he was far from the only wealthy person wielding donations to win powerful friends, or to weasel his way into the public’s good graces.
“Many organizations will say they know their donors, especially the large ones,” said H. Art Taylor, president of the Association of Fundraising Professionals (AFP), the largest network of its kind in the country. “But do we really?”
Obviously, very few people, elite donors included, have committed crimes as vile as Epstein’s. And yet, a 2023 study found that a full half of fundraisers have encountered a donor who falls along a spectrum of unsavory behavior, be it a board member with a sleazy reputation or an environmental philanthropist who has made their money in the oil industry.
Every time such a donor gives, it sparks a difficult trade-off. Is it okay to accept money from a bad person if it goes to something good? There is, after all, not enough philanthropy on offer to go around as is. But if fundraisers inevitably tread into the gray areas, where should they draw the line?
The justifications of the scientists, charities, and academics who accepted Epstein’s donations clearly do not pass the sniff test. Their knee-jerk response should’ve always been a categorical no, something nearly everyone who accepted Epstein’s money now admits.
Epstein demonstrates just how bad the worst-case scenario can be for charities and universities that take money from the wrong person. MIT Media Lab’s association with Epstein ultimately led to an avalanche of bad press, resignations from key researchers, and a permanent reputational stain. Gates could’ve spent this year basking in the warm glow of his foundation’s historic decision to donate itself out of existence, the crowning jewel of his philanthropic legacy. Instead, he will spend it apologizing to his staff, testifying to Congress, and yearning for the one that got away, his ex-wife, Melinda French Gates, who reportedly left him in part over his Epstein ties.
But bad donors can still harm good organizations even when they are not as obviously bad as Epstein proved to be. Research shows that organizations that accept toxic donations, even from less catastrophically scandalous philanthropists, often struggle to build trust with new donors in the long run, because they come to be seen as morally complicit. What might feel like a justifiable trade-off in the short-term — a dollar from a bad person is still a dollar for a good cause — can quickly devolve into a long-term liability.
Many people who took Epstein’s money later pleaded ignorance of his crimes, despite his being an unusually clear case of a rotten donor. Sure, he paid a small army of digital advisers to clean up his image a smidge, but his 2008 arrest was still eminently Googleable.
But not every shady donor is so easy to spot. Instead, said Patricia Illingworth, a professor of philanthropy and ethics at Northeastern University and author of Giving Now: Accelerating Human Rights for All, the majority “are problematic mainly because of how they made their money” or because they’ve engaged in behavior that is morally dubious, but not outright criminal.
Think of the Sackler family, who made their fortune on the highly addictive painkiller OxyContin and went on to become major donors to the Metropolitan Museum of Art, the Guggenheim, and the University of Oxford, among other arts and cultural institutions. There’s also Warren Kanders, who was forced to step down from the Whitney Museum’s board in 2019 in response to public outrage over his company’s sale of tear gas.
Illingworth believes that such people opt to give for two main non-altruistic reasons. One is reputation laundering, which has a long history in philanthropy. In 1888, Alfred Nobel read a premature obituary calling him the “Merchant of Death” for getting rich off the sale of explosives. Nobel was so spooked by the moniker that he decided to give away all of his assets to establish the Nobel Prizes. Today, the name Nobel is more broadly associated with peace and science rather than blowing stuff up. Everyone prefers to be known for their gifts to charity, not for accelerating deforestation or covering up workplace abuse.
The other reason is somewhat counterintuitive: It’s called the moral licensing loophole, a psychological phenomenon identified by the researchers Benoit Monin and Dale T. Miller in 2001. This theory states that when someone does something nice — such as giving to charity — they subconsciously feel entitled to do something bad. It’s like somebody on a diet who’s “been eating healthily for a couple of months, and then they just eat a pint of ice cream,” said Illingworth. Only in this case, the pint of ice cream may portend something far more serious.
“If it’s Jeffrey Epstein, and he comes along and says, ‘Well, I really want to make a donation to the media lab at MIT,’ then you should think twice about that,” she said. “Because he’s done a lot of bad things, and there’s a good chance that he’ll follow the good act with a bad act.”
The clearest archetype of this thinking is probably Sam Bankman-Fried, the FTX cryptocurrency fraudster, who donated over $190 million to charity before his arrest in 2022. Bankman-Fried was temporarily the most successful disciple ever of the effective altruism (EA) movement’s idea of earning to give, which encourages people to make a lot of money primarily so they can give it all away. Ultimately, however, Bankman-Fried’s fraud tarnished the credibility of effective altruism as a whole, and embarrassed many of its leaders, some of whom had been warned before about Bankman-Fried’s unethical behavior. Some charities — especially EA darlings like the Centre for Effective Altruism — lost out on millions in promised funding, and EA itself is still digging itself out.
Many have speculated that Bankman-Fried justified, or morally licensed, his crimes under the utilitarian notion that it is okay to steal if it means more money for causes like pandemic prevention and AI safety. In Twitter direct messages with my former colleague Kelsey Piper, he implied that his decisions were mostly untethered to a genuine concern about ethics, but rather were part of a “dumb game we woke westerners play where we say all the right shiboleths and so everyone likes us.”
But even so, Bankman-Fried and some of those around him still appear to have found some justification for their behavior in charity. Bankman-Fried’s ex-girlfriend and onetime top adviser, Caroline Ellison, testified that he built his crypto empire on the idea they were making money for the “greater good,” and therefore he and those in his orbit were entitled to break the rules. “It made me more willing to do things like cheat or steal,” she said.
(Disclaimer: Bankman-Fried’s philanthropic family foundation awarded Vox’s Future Perfect a grant for a 2023 reporting project that was later canceled after his arrest. Another ex-colleague, Dylan Matthews, wrote an honest and illuminating piece in the aftermath of the tainted grant.)
But it’s easy to ignore — sometimes unwittingly — when a possibly sleazy donor comes along, especially if their crimes are only rumored or appear to be morally ambiguous at the moment. Sometimes those donors turn out to be monsters, or at the very least, crooks.
While “fundraisers do a tremendous amount of work understanding who their donors are,” Taylor told me, “no one is going to go up and ask, ‘Do you have any baggage? I want to take money from you, but have you committed any crimes?’”
Disquietingly, according to a poll conducted in 2023, more than half of fundraisers said that the prevalence of toxic donors had risen in recent years. While half of the nearly 700 fundraisers surveyed had encountered a “morally tainted donor” in their work, only one-third said their employer had a policy in place for handling such donations.
Again, these are rarely the Epsteins of the world, but more commonly a broad range of people who’ve engaged in questionable moral behavior: a tech CEO whose product has sparked privacy concerns, perhaps, or a Hollywood producer accused but never convicted of sexual misconduct.
“Rarely are institutions going to be confronted with such criminals, particularly known criminals,” said Zoe Rahwan, a research scientist at the Max Planck Institute for Human Development, who conducted the poll. Rather, “it’s this area of moral ambiguity where there’s no criminal conviction” that “is really difficult territory,” she said, because “there may be a sense that the person or the company they work with does some good but also maybe does some ill for society.”
The majority of those surveyed said they would generally accept donations from people who’ve done or been accused of unethical things, but haven’t been convicted of a crime. While fewer fundraisers said they would accept a donation from someone with a criminal conviction, a full 37 percent made an exception for those convicted of white-collar crimes.
The general public, when asked a similar set of questions, said nonprofits should be able to accept donations from those accused of a broad range of unethical behavior, with 74 percent tolerating racism and more than half accepting of white-collar crimes like Bankman-Fried’s. However, they were less likely to approve of such donations if they knew the funds were directly obtained by criminal means. Over one-third said they were willing to accept gifts from donors convicted — not just suspected, but convicted — of sexual assault.
It’s not necessarily the case that people don’t care who’s giving them — or their favorite charity — money. Surely, every fundraiser would prefer to accept donations only from the most squeaky-clean sources they could find. But for most charities, there’s never been enough money to go around to be choosy. While funding shortages are particularly acute today — about 70 percent of the country’s nonprofits are facing funding cuts under the Trump administration — many groups are accustomed to operating on thin financial margins.
If an organization is in dire financial straits and “a slightly tainted donor comes along and says, ‘I’m willing to help and you don’t have to sacrifice too much of your reputation,’ you’re going to take the money,” Taylor told me. “You may even have somewhat of a fiduciary duty to at least consider taking the money.”
In the 1990s, many tobacco companies used predatory marketing practices to boost sales of menthol cigarettes in Black communities, a strategy that included offering donations to local nonprofits in those neighborhoods as a form of reputation laundering. Among them was a job training charity then led by Taylor, who said he accepted the donation with some unease.
“We felt that if they were extracting money from the Black community, then we should be using some of that money to help the Black community,” he said. “Some people were okay with that decision and that way of looking at it. Other people weren’t.”
When a shady donor comes around, there’s often no perfect way to respond. And while they may feel more conspicuous now, much of our modern social system was initially funded by very rich people who were very imperfect.
We have public libraries today partly because Andrew Carnegie decided to give away most of his fortune — which he earned in part through abusive, and sometimes deadly, labor practices — to charity. Way back in 1905, a $100,000 donation from eugenicist John D. Rockefeller sparked an impassioned debate in the Congregational Church over whether to accept a gift from an oil baron who accumulated his wealth in such an “unscrupulous and brutal way.” In the end, they took the money, as did countless medical researchers, some of whom went on to use those funds to develop a vaccine for yellow fever and popularize the use of insulin to treat diabetes.
“Controversial donors have always been here. It’s just that now we pay more attention to it.”
Marek Prokupek, KEDGE Business School
“There are those who would argue that all money in America is tainted” by some form of exploitation, even if it took place a century ago, said Taylor. “People will never always agree that the decision was right, and that’s a tension that we have to live with in the end.”
“Controversial donors have always been here,” said Marek Prokupek, a professor at KEDGE Business School who specializes in the role of ethics in arts funding. “It’s just that now we pay more attention to it.” There may be benefits to accepting money from an unsavory donor in the short-term, he said, but institutions “risk losing the trust of their communities” and losing out on new potential supporters in the long run.
And trust is everything for nonprofits, universities, museums, and other institutions whose mission is to serve a public that’s become increasingly cynical about their motivations. Fewer than one-third of Americans say they trust wealthy philanthropists to do the right thing, down from 36 percent in 2010, and nearly 60 percent believe they have too much influence over the nonprofits they fund. That skepticism appears to have also bled into their view of the organizations those philanthropists support, with just 35 percent of Americans reporting high trust in nonprofits as of September of last year. They have also themselves become less likely to donate, at least in part because they sense the charitable world’s acquiescence to the richest of the rich.
Remember the Sacklers? For decades, the Sackler name was an enduring presence across many of the world’s most storied cultural institutions, despite their patronage’s association with the development of OxyContin, which drove millions of Americans into opioid addiction. Over a five-year period alone, they gave over $60 million to prestigious universities around the world.
Then, in 2017, photographer Nan Goldin launched a protest campaign against those institutions accused of “artwashing” the Sacklers by accepting their support. She held protests at the Guggenheim and a die-in at the Louvre. “All the museums and institutions need to stop taking money from these corrupt, evil bastards,” Goldin said in a documentary about her activism. Eventually, one by one, almost all of them did.
The reputational damage and bad press that came with accepting the Sackler donations were corrosive enough that many institutions — including the Louvre, the Guggenheim, and the Metropolitan Museum of Art — decided that the money was not worth it. Research shows that tainted donors also affect institutions’ bottom line, making it harder for them to make connections with new donors or, in the case of museums, presumably sell tickets.
These days, “we expect organizations to be more accountable and more transparent, and to stand for good values,” Prokupek said, not allowing “controversial donors to wash their brand.”
You don’t want to wait until the protesters show up or the allegations accumulate to establish red lines. A good rule of thumb is that if it’s not something that you’d be willing to explain away if the world finds out, then maybe say no next time a sleazy billionaire comes knocking on your door.
Thou shalt not make a deal with the devil, even if nobody ever finds out about it. In the process of sanitizing someone else’s rotten moral character, you may well end up tainting your own.
2026-04-25 06:30:00
经过多年的投诉和诉讼，以及2022年泰勒·斯威夫特“时代巡回演唱会”门票销售争议引发的连锁反应，各州将此案提交至法庭并取得胜利。4月15日，联邦陪审团裁定Live Nation娱乐公司与Ticketmaster构成非法垄断，向粉丝过度收费并排挤竞争对手。尽管如此，现在的问题变得简单：门票价格真的会下降吗？事实证明，答案远不止是限制费用和增加竞争那么简单。了解更多关于Ticketmaster与Live Nation案件的信息：Live Nation在法庭上败诉。这将对演唱会行业产生什么影响？Ticketmaster垄断判决是否只是幻象？Ticketmaster在法庭上遭遇重大失利。
On April 15, a federal jury found that Live Nation Entertainment and Ticketmaster operated as an illegal monopoly, overcharging fans and shutting out competition.
After years of complaints and lawsuits, as well as the fallout from the 2022 Taylor Swift Eras Tour ticket sale controversy, the states took the case to trial and won.
So now the question is simple: Will ticket prices actually go down? The answer, it turns out, is more complicated than limiting fees and creating more competition.
Read more about the Ticketmaster/Live Nation case:
Live Nation lost in court. Here’s what it means for concerts.
Is the Ticketmaster Monopoly Verdict a Mirage
Ticketmaster’s Big Loss in Court
2026-04-25 06:00:00
史蒂夫·维特科夫（Steve Witkoff，右）和贾里德·库什纳（Jared Kushner，左）于2026年4月12日在巴基斯坦伊斯兰堡举行新闻发布会。| Jacquelyn Martin/pool/AFP via Getty Images
本文出自《Logoff》每日简报，旨在帮助您了解特朗普政府的动态，而不会让政治新闻占据您的生活。点击此处订阅。
欢迎来到《Logoff》：美国和伊朗外交官本周六将在巴基斯坦举行会谈，讨论结束伊朗战争的方案。以下是关键信息：
停火现状：目前停火协议仍然有效，并被延长至伊朗提交“统一方案”结束战争为止。根据特朗普本周早些时候在社交媒体上的声明，这意味着停火可能无限期持续，或直到特朗普决定改变立场。（此前停火协议将在周二晚间到期。）
谈判代表：此次谈判并非由副总统JD·范斯（JD Vance）主导。美国代表团将由中东特使史蒂夫·维特科夫和特朗普女婿贾里德·库什纳（虽非政府官员，但拥有与海湾国家的巨额商业利益）带领。与此同时，伊朗也不会派其与美国的主要谈判代表、议会议长穆罕默德·巴赫加尔（Mohammad Bagher Ghalibaf）出席。根据《纽约时报》报道，伊朗外长将提交一份书面回应，以应对美国提出的和平协议。
霍尔木兹海峡情况：海峡仍然基本封锁，美国继续对伊朗船只和港口实施封锁，而伊朗则阻止其他船只通过这一关键航道。本周早些时候，伊朗据称袭击了至少三艘试图通过海峡的船只，而美国上周则扣押了一艘伊朗船只。封锁的持续导致油价居高不下，战争对全球经济的影响（包括食品、燃料和消费品的价格与供应）进一步加深。
接下来会发生什么：我们将关注谈判的结果，但一些观察人士认为范斯的缺席可能并非积极信号。与此同时，美国的封锁仍将持续。特朗普周四在社交媒体上表示：“我们完全控制了霍尔木兹海峡，它被‘严丝合缝’地封锁着，直到伊朗能够达成协议！”
我的同事艾莉·沃尔普（Allie Volpe）报道称，独处有很多好处，但关键是要适度，不要过度。您可以点击此处阅读她关于如何更好地“下线”的精彩建议（附赠链接）。
一如既往，感谢您的阅读！祝您度过愉快的周末，我们周一再见。
This story appeared in The Logoff, a daily newsletter that helps you stay informed about the Trump administration without letting political news take over your life. Subscribe here.
Welcome to The Logoff: US and Iranian diplomats will meet again in Pakistan this weekend to discuss an end to the Iran war. Here’s what to know:
What’s the status of the ceasefire? Still in effect and extended “until such time” as Iran produces a “unified proposal” to end the war, according to a social media post by President Donald Trump earlier this week. In other words, likely indefinitely — or until Trump feels like doing otherwise. (It had been set to expire Tuesday evening prior to the extension.)
Who’s negotiating? Not Vice President JD Vance. This time, the US delegation will be led by US special envoy to the Middle East Steve Witkoff and by Jared Kushner, Trump’s son-in-law (who is not a government official, but does have billions of dollars of business interests with Gulf countries). Likewise, the Washington Post reports, Iran will not be sending its leading negotiating partner with the US, Parliament speaker Mohammad Bagher Ghalibaf.
Instead, according to the New York Times, Iran’s foreign minister will present a written response to a proposed US peace deal.
How’s the Strait of Hormuz looking? Still largely closed, as the US continues its blockade of Iranian vessels and ports, and Iran continues to bottle up any other traffic through the key waterway. Earlier this week, Iran reportedly fired on at least three vessels trying to transit the strait, and the US seized an Iranian vessel last weekend.
The continued closure means that oil costs remain high as the war’s impact on the global economy — including on the prices and availability of food, fuel, and consumer goods — deepens.
What comes next? We’ll see what comes out of the negotiations, though some close watchers have suggested that Vance’s absence is likely not an encouraging sign.
In the meantime, the US blockade will remain in effect: “We have total control over the Strait of Hormuz,” Trump posted on Thursday. “It is ‘Sealed up Tight,’ until such time as Iran is able to make a DEAL!!!”
Solitude has lots of benefits, my colleague Allie Volpe reports — but it’s best if you do it right, and don’t overdo it. You can read her excellent advice here with a gift link (think of it as advice on how to log off better).
As always, thanks for reading! Have a great weekend, and we’ll see you right back here on Monday.
2026-04-25 02:20:44
2026年4月18日，纽约市市长佐赫兰·马姆达尼（Zohran Mamdani）在布朗克斯区的“通过游戏学习”幼儿园（Learning Through Play Pre-K）与孩子们互动。在去年秋季取得历史性胜利后，马姆达尼本月迎来了上任100天。目前他的支持率总体积极，已兑现部分竞选承诺，并成功应对了年初的两次严重暴风雪挑战。此外，他还成功赢得了特朗普的青睐。马姆达尼的表现也引发民主党对未来的思考：他的成功是否预示着党的未来方向？这种成功能否在全国范围内复制？党是否愿意倾听新一代的声音？
前奥巴马国家安全顾问本·罗兹（Ben Rhodes）现在是播客《Pod Save the World》的主持人。在今日解释（Today, Explained）节目主持人塞安·拉梅斯瓦拉姆（Sean Rameswaram）的采访中，罗兹分析了马姆达尼在党内的影响。他认为，马姆达尼的受欢迎程度反映了民主党内部对新一代政治人物的期待，尤其是那些更具亲和力、更贴近现实的候选人。然而，像参议员查克·舒默（Chuck Schumer）这样的传统派则对马姆达尼持保留态度，担心其激进立场可能影响党的议程控制。
罗兹指出，马姆达尼在与特朗普的互动和沟通能力上表现突出，这与舒默等老派政客形成鲜明对比。马姆达尼的背景和风格（如曾是说唱歌手、热爱体育和文化、擅长社交媒体）使他显得独特，这种特质难以复制。但即便没有这些特殊背景，年轻且真实的候选人（如缅因州的格雷厄姆·普拉特纳、密歇根州的哈莉·斯蒂文斯）也能在党内初选中表现出色。
罗兹还提到，马姆达尼并非美国出生，这可能限制他成为全国性政治人物的潜力。然而，这也让他能够专注于纽约本地事务，而不必像其他年轻政客（如亚历山德里娅·奥卡西奥-科尔特斯、乔恩·奥索夫、詹姆斯·塔拉里科）那样急于竞选总统。这种“去总统化”的定位，虽然可能失去一些政治野心，但也为他提供了更灵活的发展空间。
After a historic victory last fall, New York City Mayor Zohran Mamdani marked 100 days in office earlier this month.
So far, it’s going pretty well: His approval numbers are broadly positive, he’s begun to deliver on some of his key campaign promises, and he weathered his first major challenge as mayor after NYC endured two serious winter storms earlier in the year. (He’s also successfully charmed President Donald Trump not once but twice.)
Mamdani’s track record also suggests some questions for the Democratic Party as it heads into the midterms. Among them: Is Mamdani’s success a glimpse into the party’s future? How much of it can be replicated outside of New York or on a national stage? And how much is the party willing to listen?
Ben Rhodes was a deputy national security adviser and close aide to Barack Obama. He’s now an author and co-host of Pod Save the World, a podcast about world news and foreign policy. Today, Explained co-host Sean Rameswaram, asked Rhodes what lessons the party can draw from Mamdani and which candidates are sticking out as possible Mamdani-esque successes.
Below is an excerpt of the conversation, edited for length and clarity. There’s much more in the full podcast, so listen to Today, Explained wherever you get podcasts, including Apple Podcasts, Pandora, and Spotify.
You’re here to help us understand how [Mamdani]’s being perceived within the party. How’s he being spoken about inside that Democratic tent?
It’s interesting because there are two cleavages in the Democratic Party. One is between left and center. But the other is more about body language. Do you understand what is happening? Do you understand the scale of the danger that Trump poses? Do you understand the scale of the disgust that people feel for the Democratic Party and politics in general? Do you understand the need for generational change?
I think that Mamdani has excited just about everybody that is either on the progressive end of the spectrum in the party or who’s just eager for newer, younger faces who understand what’s going on, who do politics in a different way, who don’t feel like repurposing of the old talking points for the umpteenth time. And so there’s a bunch of people that see him as an opportunity, someone to follow, someone to emulate.
Then I think there’s Democrats that are terrified of Zohran Mamdani because of all those things. Let’s just take Chuck Schumer, who’s the stand-in for a lot of the Democratic establishment that people are frustrated with — who didn’t even endorse Mamdani, even though he is from New York. Obviously he’s ambivalent about Mamdani’s politics on Israel and Palestine. He’s reluctant to let go of the reins to a new generation in the same way that we saw Joe Biden be reluctant in his time in office. He’s internalized these fights between the left wing of the party and the center and is worried about the ascendancy of a democratic socialist and losing control of an agenda that is usually dictated from Washington, not the other way around.
I think Mamdani has been — I don’t want to say polarizing, because the Schumers of the world can’t really speak out against Mamdani anymore because he’s so popular at this point. But I do think that there are people that are ambivalent and then there are people that are excited and the number of excited people is the growing quotient.
Looking at him next to a figure like Schumer, the contrast is so apparent in two buckets: One, he’s a much better communicator. And then two, he seems to be way better at dealing with the president.
Are these the two buckets that Democrats who are in office or maybe even aspiring to national office are most focused on?
Those are two of the primary buckets. There’s obviously questions about what does the Democratic Party stand for on certain issues.
But the standing up to the president, let’s just start there. Mamdani has proven what a lot of Democrats suspect, which is that our leadership has completely failed to figure out a way to deal with Trump. They’re either railing against him in public and not able to do anything in private, or they’re trying to cut a deal in the old-fashioned way.
“He’s singularly talented and he has that kind of uniqueness that Obama had.”
That has not worked, and so I think Mamdani shows, “Hey, you can be smart about this and be completely uncompromising and Trump will actually respect you more.”
On the communication side, it helps that Mamdani is a charismatic politician. It helps that he’s a very likable politician. He speaks like a normal human being. And the Chuck Schumers of the world do not. It’s always some kind of seemingly poll-tested phrase about the middle class that is designed to offend the least people and therefore says absolutely nothing, whereas Mamdani just sounds like a normal guy, like an authentic person who’s just telling you what he believes, and I think people trust that he’s telling you what he believes.
People have heard him take stances that were controversial. I actually think in this case, his positions on Gaza helped validate his positions on affordability because people are like, “Well, this guy’s willing to go out and pick some really big fights and he’s not going to budge. I’m more likely to believe that he’s going to fight to lower my rent because he has principles that he’ll stand on.” And people don’t trust a lot of the mainstream Democratic politicians that they will actually be there when the fight comes.
You worked for a guy who was singular. Is Mamdani sort of singular? I mean, he’s 34 years old. He’s a former rapper. He loves sports, he loves culture. He understands social media. You can’t implant that into a Schumer or even Schumer’s team, necessarily.
He’s singularly talented and he has that kind of uniqueness that Obama had. His background is different. He presents differently. Now, I actually think that where it can be replicated, even if you don’t have Mamdani’s singular talents or background, is the authenticity and generational point: Younger people that just sound normal and look normal.
If you look in the Democratic Senate primaries, some people have overperformed often against the party establishment’s choices: Graham Platner in Maine. Graham Platner sounds like a normal guy and he’s 30 years younger than Janet Mills, the governor of Maine, who’s the preferred candidate of Chuck Schumer and the Democratic campaign committee. If you look at Michigan: Haley Stevens, a very conventional politician, is the preferred candidate of the DSCC. There are two candidates, Mallory McMorrow and Abdul El-Sayed, who present as more normal.
And this isn’t a left-center thing. This is just a younger and more authentic kind of politician.
As someone who worked for the previous generational politician in the Democratic Party, does it bum you out that [Mamdani] being born in another country might limit how much of a generational politician he gets to become?
It crossed my mind. I will say, it does make him an interesting figure. We’ve never had a figure, at least in my recent memory, who could end up being such a prominent politician at such a young age with a ceiling that is lower than the presidency. And what he chooses to do with that is quite interesting.
Is it just, “I’m a New York City guy and that’s what I’m doing. I’m running through the tape as mayor, and then I want to work in the city?” Is it “I become a New York state politician?” Is it “I become some kind of national figure separate from being president?”
It does in some ways free him of a burden in some respect. Because you’ve seen this with AOC, with any young politician. I mean, they’re already talking about [Sen. Jon] Ossoff in Georgia or if [state Rep. James] Talarico wins [in Texas], they’ll start talking about the presidency the next day.
It frees him up where every move that he makes isn’t like, “Is he positioning himself to one day run for president?” And so in that way, something is lost, but something is potentially gained too.
2026-04-24 19:15:00
在美国，理论上避免感染HIV变得异常容易，但现实中许多人仍难以获得预防性药物PrEP（暴露前预防）。Brenton Williams因未婚妻HIV阳性而成为PrEP的潜在受益者，但他却因医生对PrEP了解不足而迟迟未能获得药物。数据显示，尽管PrEP对预防HIV感染效果高达99%，但美国仅约三分之一的高危人群正在使用它，且最需要它的群体（如黑人和拉丁裔双性恋及同性恋男性、女性和南方居民）使用率远低于平均水平。
PrEP的使用面临多重障碍：许多人不了解该药物，医生对PrEP的掌握程度不足，且存在社会污名。此外，尽管大多数保险计划覆盖PrEP费用，但部分人群仍需自费每月高达2000美元。对于无保险者，虽然有州级项目和药厂援助计划，但缺乏类似“瑞安·怀特艾滋病项目”的联邦预防资金支持。同时，PrEP需要定期医疗随访，导致许多人难以坚持使用。
近年来，通过远程医疗平台（如MISTR和SISTR）以及注射型PrEP（如Apretude和Lenacapavir）的推广，PrEP的可及性有所提升。注射型药物只需每两个月注射一次，且6个月后仍保持80%以上的使用率，比每日服药的50%更高。然而，这些注射服务仍需在诊所进行，且费用高昂，目前MISTR尚未开放实体诊所。此外，许多州已允许药剂师开具PrEP处方，推动其普及。
政治因素也影响了PrEP的推广。特朗普政府削减了HIV预防和治疗项目的资金，导致地方诊所的PrEP推广工作受阻。尽管红州在特朗普削减后仍维持治疗资金，但预防项目仍面临威胁。拉丁裔社区因移民政策的争议，对医疗资源的获取更加困难，甚至出现因担心移民执法而不敢前往诊所的情况。
尽管挑战重重，专家认为美国已具备终结HIV疫情的工具。例如，约翰霍普金斯护理学院的Vincent Guilamo-Ramos指出，通过社区推广和政策支持，HIV是可以被消除的。然而，当前的障碍包括资金不足、医疗系统不平等以及对PrEP的误解。例如，黑人和拉丁裔群体仅占PrEP使用者的16%和近一半，尽管他们占新诊断病例的近40%。女性和有色人种的PrEP使用率也远低于其风险水平。
个人故事进一步凸显问题。Gail Prince在发现伴侣故意传染她性病后，通过社区诊所开始使用PrEP，并重新找回了自我价值。她表示，PrEP让她能够专注于家庭生活，而非依赖他人保护。类似地，Brenton Williams仍在努力争取获得PrEP，他计划通过与医生沟通或转向专门服务群体的诊所来解决这一问题。
总体而言，虽然PrEP的普及率在上升（2023-2024年增长约17%），但其推广仍面临系统性障碍。专家呼吁加强政策支持、消除污名，并扩大社区服务，以确保所有高危人群都能获得这一重要预防工具。正如Guilamo-Ramos所说，尽管存在诸多挑战，但终结HIV疫情仍有可能，关键在于持续的行动和资源投入。
Brenton Williams finally felt he had the proper health insurance to ask his doctor about PrEP (Pre-Exposure Prophylaxis), a highly protective drug regimen for people at risk of HIV. Williams’ fiancée is HIV positive, which should have made him the perfect candidate for PrEP, which prevents HIV transmission in the event of exposure to the virus. “I just really wanted this extra layer of protection,” he said.
His doctor wasn’t so sure.
“Well, what do you need it for?” she probed, before offering to “look into it.” Williams sensed that she was trying to change the subject.
“I don’t understand what the hold up is,” Williams told me two months after his initial appointment requesting the medication. As far as he could tell, his doctor seemed unclear about best practices for prescribing PrE, telling Williams that she needed to learn more about it herself. Williams had completed all of the necessary lab work along with a full physical, but he still hadn’t gotten access to the drug. “I definitely want to continue to have sex, but I also want to keep my body safe,” he told me.
In theory, it has become miraculously easy to avoid getting HIV in the United States today.
For people who are HIV negative, a once-daily PrEP pill can prevent infection during sex with someone who is HIV positive no less than 99 percent of the time. At the same time, most of the 1.2 million Americans living with HIV follow an anti-retroviral therapy regimen that is so effective that it can make their HIV non-transmissible. These treatments are both a marvel of modern medicine and a living tribute to the more than 700,000 Americans who have lost their lives to HIV since the first reported cases appeared in 1981.
Getting on PrEP, which was approved by the FDA in 2012, should be about as easy as getting on birth control, another daily pill prescribed for sexual health. In both cases, side effects are minimal and rare, and the costs are covered by most insurance plans.
But despite all that, PrEP remains exasperatingly out of reach for hundreds of thousands of people in the US who need it. Most Americans — about 60 percent — don’t know about PrEP in the first place. Even if they do know enough — and have the health coverage they need — to ask a doctor about it, less than half of physicians feel knowledgeable enough to prescribe PrEP, as Williams found. And other people still often struggle with stigma from their communities and even from their health care providers.
As a result, only about one-third of people at risk of HIV in the US currently take PrEP. Worse yet, those who are the most likely to benefit from its protection are often the least likely to be on the medication. Among people at risk of HIV, Black and Latino bisexual and gay men, women, and Southerners consistently take PrEP at much lower levels than the rest of the population, which may account for the troubling increase in new HIV infections over the past decade in some areas in the US.
“We’ve had a dramatic drop in new infections over the past 15 years, but we’ve plateaued, and we’ve plateaued among those same vulnerable populations,” said Carl Baloney Jr., president of AIDSUnited. People like Brenton Williams can do everything right, he said, and yet, they still get lost in the cracks of this country’s warped health system, either because they lack health insurance, or because their providers don’t know about PrEP well enough to prescribe it.
The gaps in PrEP coverage may soon get even wider, because the Trump administration has slashed hundreds of millions of dollars in grants earmarked for PrEP outreach and HIV prevention. It is a maddening time to be an HIV advocate in the United States. After decades of getting to the point where an America free of HIV seemed in sight, the country feels on the verge of a tragic reversal. And the availability of PrEP is one of the most important factors in deciding what comes next.
“This is a disease that, with some strong policy support and political will, we could end in this country very quickly,” Baloney Jr. said. “There’s really no excuse for there to be new infections at any measurable rate in the United States of America.”
Ironically, some of the challenges facing PrEP come from the incredible success of battling HIV. Almost everyone under the age of 35 is too young to remember a time before antiretrovirals, when HIV was a death sentence.
“The scope and the awareness of HIV really changed once more people were living with HIV than dying of HIV,” Danielle Houston, executive director of the Southern AIDS Coalition, said. That is a massive achievement, she said, but one that has also “cloaked the actual epidemic” from public view.
“The scope and the awareness of HIV really changed once more people were living with HIV than dying of HIV.”
Danielle Houston, southern aids coalition
And though HIV has become much, much more treatable, it is still a widespread disease, more so in some communities than in others. In Washington, DC, for instance, nearly one in 50 residents has HIV, among the highest rates in the country. Even with strict treatment regimens — which can cost upwards of $1 million over a patient’s lifetime — people living with HIV suffer from higher risks of heart disease and other comorbidities.
But the burden is not distributed equally, meaning that, in some communities, the actual HIV rate is much higher. At current rates, 1 in 15 white gay and bisexual men nationally will be diagnosed with HIV in their lifetime. For Black gay and bisexual men, the likelihood rises to a startling 1 in 3. For Latino gay and bisexual men, it is 1 in 4. In DC, for example, the rate of HIV is starkly segregated, with new infections highly concentrated in the city’s predominantly Black neighborhoods.
And while more and more people are taking PrEP each year, progress on reducing HIV rates overall has largely stalled and has even reversed in some communities — a trend that’s tightly linked to PrEP usage rates. States with high levels of PrEP coverage, like New York and Vermont, saw a 38 percent decrease in new HIV diagnoses between 2012 and 2022, while those with low PrEP coverage , like West Virginia and Wyoming, saw a 27 percent increase, according to a report by AIDSVu.
Black Americans are by far the most likely to be impacted by HIV in this country, facing new infection rates at much higher levels today than have ever been reliably recorded among white Americans. In recent years, Latinos have faced an alarming increase in new infections, with rates rising nearly 20 percent between 2018 and 2022.
And both communities of color and women take PrEP at low rates, relative to their risk of HIV. Black people account for nearly 40 percent of all new HIV diagnoses but make up only 16 percent of PrEP users, the majority of whom are white. One in five HIV infections occur in women, but they account for only one in 10 PrEP users.
Some of that may be due to the dangerously false perceptions that women rarely get HIV and are therefore less likely to benefit from preventative services. Marnina Miller, Williams’ fiancée and co-executive director of the Positive Women’s Network, a group advocating for people living with HIV, first tested positive for the virus in 2013, a time when PrEP existed but was poorly understood — stigmatized as a “party drug” on the grounds that it supposedly encouraged promiscuity and barely on the radar of most women. Even now, “women are continuously an afterthought in the HIV epidemic,” she said.
Black and Latino communities also have less access to PrEP as an extension of much broader, deeply entrenched healthcare disparities. “It’s not that women, Black, Hispanic, or Latinx individuals, or Southern individuals are being less responsible about their sexual health,” said Houston. “They’re more vulnerable to healthcare systems and policy changes” that put treatment and preventative services like PrEP out of reach.
Insurance to cover the medication — which can cost up to $2,000 per month out of pocket — is one barrier for many people. While there are options to get help paying for PrEP if people don’t have insurance, like state-level PrEP programs or patient assistance programs offered by the drug manufacturers themselves, there’s no preventative equivalent to the federally funded Ryan White HIV/AIDS Program, which supports people living with HIV who are uninsured or otherwise can’t afford treatment.
Individuals also have to jump through hoops to make sure that not just the medication but also all of the other costs associated with PrEP — “the HIV testing, the labs, the doctors visits” — are covered, said Jeremiah Johnson, executive director of the advocacy group PrEP4All.
And then, even if they do get a prescription, most Americans take PrEP in the form of a once-a-day-pill, with requirements to check in with their doctor every 3 months to renew their prescription. Not coincidentally, somewhere between 37 and 62 percent stop taking PrEP within six months of starting.
“The thing that we’ve heard repeatedly from PrEP users,” Johnson told me, “is that that’s an awful lot of work for a disease that you don’t have.”
Navigating the PrEP landscape can be daunting in other ways, too, with critical information often arriving to people late, if it arrives at all. Only one of the two FDA-approved PrEP pills — Truvada — is legally approved for people assigned female at birth. Williams, who is a trans man, was unaware of this until I mentioned it during our call. “I had no clue,” he said. “This is the first time I’m hearing this, but it’s the kind of thing my doctor should have said to me.”
This pattern of unawareness about potentially life-changing treatments came up frequently in my conversations with advocates.
“Hearing about PrEP and what it could do to keep me HIV negative was transformative,” said Baloney Jr., of AIDSUnited, of when he learned about the pill a decade ago. As a Black gay man, he said, “the first question I had was: How am I just hearing about this now?”
The good news is, more people are hearing about PrEP now. Between 2023 and 2024, PrEP use increased by about 17 percent. A huge part of that increase was the explosive growth in access via telemedicine driven mostly by MISTR, a telehealth platform — and its femme spinoff, SISTR — which now provides about one in five PrEP prescriptions in the United States, according to a study by researchers at Emory University’s Rollins School of Public Health.
Tristan Schukraft, an entrepreneur and self-professed “CEO of everything gay” who owns a luxury boutique hotel chain and a popular gay bar in West Hollywood, founded MISTR in 2018, because “a lot of my friends were having challenges getting on PrEP,” he told me. “I realized that there has got to be a better way.”
While some might assume that telehealth platforms skew towards “white men or people with means,” said Schukraft, almost half of MISTR’s users are people of color, higher than the average PrEP ratio, according to the Emory University study. More than three-quarters of the platform’s customers have never used PrEP before, and one-third are uninsured. (MISTR also helps uninsured patients navigate options for covering the cost.)
Getting on PrEP is hard if it’s not available at “places where people are already at, whether that’s through telemedicine or a brick-and-mortar location that’s truly accessible to them,” said Johnson of PreP4All. He credited MISTR and initiatives like Iowa’s state TelePrEP program with actively “transforming PrEP access for people.”
Many people still benefit from community-based outreach too.
Take Gail Prince, a grandmother who found out in 2024 that her partner of 30 years had knowingly infected her with an STI that he had been secretly taking medicine to treat. Almost immediately, “I went down to the court building and filed the divorce papers,” she said. “I was like, ‘No one else is going to protect me as I could.’”
Prince went to get tested for HIV at the Women’s Collective, a clinic in DC that specializes in HIV-related services for women of color. She was negative. But after her husband’s betrayal, “I felt like I was nothing, dirty,” she said. “I didn’t take care of myself.” She stopped getting her hair done. But not for too long.
“I knew that I had to actually think about myself in order to be here to see my grandkids graduate from high school and college,” said Prince, who has since gotten back on the dating scene, now protected by PrEP, which she learned about at the Women’s Collective. “It makes me feel better, because I know I’m coming first. I’m not waiting for a man who might not tell you anything.”
She gets her PrEP through Women’s Collective and also uses their food pantry and participates in some of their social groups, like their weekly “Coffee House” chats, further connecting her to the organization and its supports.
“Organizations like ours know that it’s not just about HIV,” Valerie Rochester, executive director of the Women’s Collective, said. “It’s about everything that is involved in a person’s life” that “could potentially prevent them from seeking medical care,” like housing insecurity, a lack of social support, or substance misuse. “We’re always looking to expand any ways that we can find to engage a client and keep them coming back.”
Prince is one of the small fraction of people on PrEP in the United States who get the medication through a shot every two months instead of a once daily pill. She started off on the pill Truvada, but like about half of PrEP users, “it wasn’t really working for me,” she said. “I was forgetting to take it.” So when the Women’s Collective introduced her to Apretude, which is a once-every-two-month shot rather than a daily pill, she jumped at the chance.
Such injectable forms of PrEP — including the recently-approved Lenacapavir, which requires jabs only once every six months — have the potential to radically increase the number of people protected from HIV. Over 80 percent of people who go the injectables route are still on PrEP six months after they begin treatment, compared with about half who take the daily pill.
PrEP injections do have to be given in a clinic, which has led MISTR to set up – though not yet open – seven brick-and-mortar locations located in “gayborhoods” across the country. Patients will be able to visit them to get their biannual long-acting PrEP injections, which Schukraft called a “game-changer” — as long as people can afford it. MISTR is holding off on actually opening shop at those locations until more insurance companies begin covering the shots, which can otherwise cost almost $30,000 per patient per year.
Many states also now allow pharmacists, rather than just doctors, to prescribe PrEP. And as injectables go mainstream, advocates are working to try to ensure more pharmacies are authorized to administer them.
One day, getting on PrEP may be just as accessible, destigmatized, and routine as getting on birth control or obtaining other sexual health treatments. “Say you go and grab your Plan B; there’s PrEP right next to it,” said Miller, of the Positive Women’s Network, who hopes to see a world where “prevention will be an everyday occurrence.”
“We actually have the tools. We know how to eliminate HIV, and so, we can still turn this around.”
Vincent Guilamo-Ramos, Institute for Policy Studies at the Johns Hopkins School of Nursing
The country is not there yet, but it has been getting closer. Or,l at least, it was before the Trump administration began gutting the Centers for Disease Control’s HIV prevention and treatment programs and defunding local clinics doing PrEP outreach work last year. While even red states have been shamed into maintaining funds for HIV treatment in the wake of the Trump cuts, prevention programs remain threatened at a time when PrEP could be more accessible than ever.
In 2024, the Biden administration appointed Miller as a member of the Presidential Advisory Council on HIV/AIDS, which has been around since 1995. But Trump — who pledged to end the HIV epidemic in the US by 2030 during his State of the Union address in 2019 — dismissed the council last year alongside the entire staff of the Office of Infectious Diseases and HIV Policy.
Vincent Guilamo-Ramos, director of the Institute for Policy Studies at the Johns Hopkins School of Nursing, is especially concerned about the impact of the Trump administration on Latino communities, who were already experiencing a largely hidden surge in HIV diagnoses in recent years.
The Trump administration’s anti-immigrant rhetoric has likely made a growing problem even worse, he said. There’s been “a chilling effect for the entire Latino community” when it comes to seeking medical care or even gathering in public, and that has extended to HIV prevention efforts. A few months ago, Guilamo-Ramos accompanied a mobile clinic that parked outside of a popular gay Latino nightclub to offer testing and treatment in downtown LA. Normally, he says, such “bilingual and bicultural” community outreach is the gold standard for getting more people on PrEP.
But, this time, he said, the club was empty. “I said, ‘Where is everybody? It’s Friday night. People should be out,’” said Guilamo-Ramos. A clinic worker told him that people were “afraid to come” because of concerns about immigration raids.
It’s been harder to continue to engage, to reach people through grassroots community efforts, he said, “which is really the way to get to people who may have less experience with the health care system.”
But like many other health care workers who’ve fought to eradicate HIV, Guilamo-Ramos has seen enough to know that this is not the time to give up. In the early 1990s, his job was essentially palliative care for HIV-positive patients, helping “people to make meaning out of whatever time they were fortunate to have left,” he said. “That has changed dramatically.”
“Despite all these barriers,” the fears, and the funding cuts, “the thing that is most hopeful, which keeps me going, is that we actually have the tools,” he said. “We know how to eliminate HIV, and so, we can still turn this around.”
For his part, Williams is still fighting to get on PrEP. He plans to take off work for his birthday this month and visit his doctor to advocate for a prescription once and for all. If that doesn’t work, he’ll turn to another clinic, he says — one that specializes in serving people like him.
The stakes are simply too high, and he has put too much time and effort into this already to give up. But it should never have been this hard. “I still have to advocate every time I communicate with them” about PrEP, he told me, which is outlandish, “because this is something they themselves should be pushing” more people to take.
“I’m trying to be patient,” he said, but lately, that patience has been wearing thin.