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 PrEP, 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 Food and Drug Administration 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.”

“An awful lot of work for a disease you don’t have”

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.

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 upward 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, one 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 one in three. For Latino gay and bisexual men, it is one in four. 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.”

How to get more people on PrEP

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 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 toward “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. 

A country without HIV is now within reach — but at risk

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.”

The country is not there yet, but it has been getting closer. Or, at least, it was before the Trump administration began gutting the Centers for Disease Control and Prevention’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.

Ah, Tax Day. 

If you’ve been staring at your tax bill and wondering how to keep more of your money, money, money to yourself next year, you might consider taking a page out of the billionaire’s playbook. You could be like Steve Ballmer and write off the costs of buying a sports team, or make like Mark Zuckerberg and dial down your salary to just $1 per year. 

Or, if those things seem daunting, you might just donate to charity instead.

Every year, the US Treasury loses upward of $65 billion in revenue — enough money to pay for a national universal pre-K program by one count — to charitable deductions. But while Americans of all income levels give back, it’s the richest Americans who have reaped almost all of the benefits on their tax bill.

Over nine in 10 Americans won’t claim the charitable tax break this year because it only makes financial sense for people who have enough expenses to “itemize” their taxes, rather than take a standardized deduction — though that may be changing next tax cycle. 

Meanwhile, over 80 percent of the country’s wealthiest earners — the millionaires and multimillionaires who almost always itemize — get money back for every dollar they give to charity. 

Rewarding such giving means more money for charity — one model estimates that giving would fall by as much as $50 billion a year if the deduction were eliminated. But the policy also means less revenue for the government.

Michael Bloomberg, for example, gave about $4.3 billion to charity last year, mostly through his own foundation. That would in theory translate into a $1.6 billion tax break, assuming he’s taxed at the top income rate of 37 percent. So by this count, the donations really only cost him $2.7 billion. Even for those who aren’t quite as wealthy, tax-deductible donations are sort of like buying a $20 gift card that you only need to pay $13 for, earmarked for a charity of your choice. 

That is a good thing or a bad thing, depending on who you ask. Many wealthy people use their philanthropy to underwrite causes that go underfunded by governments, such as malaria prevention, racial justice, and the clean energy transition. 

“I believe the money will be of more use to society if disbursed philanthropically than if it is used to slightly reduce an ever-increasing US debt,” Warren Buffett told ProPublica, which found that the 95-year-old billionaire paid just 10 cents in taxes for every $100 he added to his wealth between 2014 and 2018.

But critics point out that many wealthy people don’t donate like normal people do. Instead of writing checks directly to working charities, over 41 cents of every dollar donated in the US gets stashed in private foundations or donor-advised funds, which are charitable accounts. While donors get an immediate tax break for giving to these intermediaries, such charitable vehicles often take their sweet time doling out donations to actual charities, while the cash accumulates in their accounts, sometimes for years. Eventually, much of it may go to their own affiliated charitable projects or educational or cultural institutions that often cater to the wealthy, such as art galleries and Ivy League schools. 

“I don’t think we should assume that what’s done with philanthropy is better than what’s done with tax dollars,” Ray D. Madoff, a tax lawyer and author of The Second Estate: How the Tax Code Made an American Aristocracy, wrote in The Conversation in January. “The money is often landing in what’s essentially a halfway house, with no obligation to get out.”

What this means for your tax bill

The fact that most Americans don’t see their charity reflected on their tax bill affects how they give. 

While the charitable deduction has always been implicitly aimed at the elite, the 2017 Tax Cuts and Jobs Act made it even less accessible for low- and middle-income families. The law nearly doubled the standard deduction to $12,000, which meant far fewer Americans had enough expenses to justify itemizing their deductions. That caused the number of households claiming the benefit to plunge from 37 million in 2017 to just 16 million in 2018. 

While the very wealthiest households continued to benefit, the share of middle-income families claiming the benefit fell by two-thirds, from 17 percent to just over 5 percent. Even among high-income households making between $216,800 and $307,900 per year, only 40 percent took the deduction in 2018, down from 78 percent the year prior.

In tandem, the number of everyday Americans giving to charity continued to drop precipitously. Researchers at Indiana University estimate that the 2017 bill led to a $20 billion decline in charitable giving, with families that no longer benefit from deduction reducing their donations by an average of $880 each year.

President Donald Trump’s One Big Beautiful Bill, however, did indeed do one big, beautiful thing for the charitable tax deduction. This time next year, Americans who don’t itemize their taxes — again, nine in 10 of us — will be able to lop off $1,000 in charitable contributions from their taxable income, or $2,000 for joint filers. 

The Generosity Commission, which aims to encourage more Americans to give, has been advocating for such a change for years. And while it is not enough to radically reshape who primarily benefits from the tax break, researchers believe that it could lead 8 million more households to give to charity in the long run, leading to about $4.39 billion in new annual donations that they wouldn’t have made otherwise.

Someone who earns $65,000 and gives $350 to their church or local school each year will now pay $77 less in taxes if they remember to document their gifts. Their $350 donation will effectively only cost them $273.

Most Americans, including a full 70 percent of Zoomers and 57 percent of millennials, say they would give more to charity if they could write it off on their taxes. It will probably take time for them to catch wind of the fact that now, they finally can.

There’s a trade-off, though: The bill also made the tax break a little less lucrative for corporations and top earners. Researchers estimate that despite the multibillion-dollar increase in new donors, the changes will lead to a $5.67 billion reduction in charity overall each year — equivalent to a 1 percent drop in US giving — because wealthy donors may be less inclined to donate as much as they used to, which would mean the change would be a net negative for charity. And since the top 1 percent of households play an outsized role in philanthropy — accounting for one-third of all charitable giving — their retreat could have profound consequences for the causes and nonprofits they support.

But most Americans who give to charity aren’t in it for the tax break. They donate because they are trying to make a difference — sometimes for a cause they care about, sometimes simply in the life of a friend or neighbor. Almost three-quarters of them have given to an organization like a food bank or animal shelter in the past year, according to a poll by the AP-NORC Center for Public Affairs Research, and even more have donated to crowdfunding campaigns or given goods like canned food. 

Those ordinary donors typically aren’t rushing to pile up end-of-year donation receipts that they can write off on their tax forms. Most gave less than $500 each year, probably because while they’d like to give more, they often feel they can’t afford it. (Though as my colleague Sigal Samuel has written, nearly all of us can find ways to give if we try hard enough.)

Still, a boost from the charitable tax break could help. And if regular donors start giving more now, then by this time next year, they may finally get the break that they deserve, too. 

We’re making this story accessible to all readers as a public service. At Vox, our mission is to help everyone access essential information that empowers them. Support our journalism by becoming a member today.

In the less than two weeks since the US and Israel began bombing Iran in late February, the war has already killed over 1,900 people across 11 countries and displaced up to 3.2 million people. It has destroyed schools, hospitals, and critical infrastructure across the region, and threatens to plunge countries near and far — many of which rely on now-disrupted shipping routes for fuel and fertilizer — into economic and humanitarian crises.

If the escalating conflict feels to you like one more in a long slog of painfully violent, complex global crises, then you are not wrong. There are indeed more wars and armed conflicts today than there have been at any time since the end of World War II. Over one-fifth of the world’s kids now live in places warped by conflict, which magnifies poverty and hunger. And conflict doesn’t just worsen conditions on the ground — it makes getting humanitarian aid flowing to those who need it most an extraordinarily difficult and dangerous task. 

But difficult doesn’t mean impossible. Local aid workers across the region have been working nonstop to get civilians safely fed and cared for, while new methods of crisis response mean that the world may soon be able to move money much more quickly to the people and places that need it most. And while just how long this war will continue may only be known to President Donald Trump, these organizations will need support to fuel long-term recovery for those both directly and indirectly affected by the violence. The fighting has effectively closed the Strait of Hormuz, a narrow shipping lane between Iran and Oman that supplies about a quarter of the world’s seaborne oil trade and more than a third of the world’s fertilizer. A prolonged closure could quickly devolve into a major global food crisis, including a spike in hunger in the countries most vulnerable to it.

For the average person, thinking about how to help in a conflict like this can feel daunting, to say the least. It might even seem pointless against the sheer momentum of war. If you can’t solve everything — if the war has no end in sight — then why bother with Band-Aid solutions at all? 

But people need help now, so they can make it to the day after. And with global aid cuts siphoning off support for humanitarian relief organizations even as conflict spikes, your donations are genuinely more important than ever. Here’s how to help.

Give to organizations already on the ground

One way to think about the complexities of getting aid to a conflict zone is to imagine a natural disaster that lasts not for hours or days, but for weeks, months, or years on end. “With a hurricane or flood, the hazard has likely passed” by the time aid starts pouring in, said Patricia McIlreavy, CEO of the Center for Disaster Philanthropy. 

But when it comes to complex manmade humanitarian disasters like war, “that hazard is continuing,” she said, meaning that the damage and logistical challenges of coordinating relief in the fog of war can quickly compound as time goes on. 

If you’re in the US, giving directly to organizations based in Iran is complicated by American sanctions on the country, though humanitarian projects are generally exempt. But you can donate to global relief organizations, like the International Committee of the Red Cross and the Norwegian Refugee Council, many of which do work in Iran and across the region. 

Other groups, like Project HOPE, are actively monitoring the needs of many Iranian refugees, while focusing their relief efforts on the fallout among Iran’s most vulnerable neighbors. 

In Lebanon, home to the world’s highest refugee population per capita, escalating hostilities have led to a mounting humanitarian crisis in a country still recovering from its last war with Israel, which technically ended in 2024. Even prior to the new hostilities, Lebanon was experiencing a severe economic collapse, with nearly 70 percent of the country in need of humanitarian assistance.

• Trusted aid groups like Jesuit Refugee Service, the International Rescue Committee, Project HOPE, Humanity & Inclusion, and Relief International have longstanding teams on the ground working with local partners to offer emergency health services, food, shelter, and mental health support to people in Lebanon and across the region.
• Doctors Without Borders and the International Committee of the Red Cross have been ramping up medical and humanitarian support across the region since the war began.
• Anera has decades of experience distributing aid in Lebanon, and has been providing food, hygiene kits, bedding, and mattresses to those displaced.
• Save the Children is distributing child-focused supplies and responding to the needs of children and families impacted by airstrikes in Lebanon and around the region.
• GlobalGiving has a rolling relief fund providing flexible support to vetted, local organizations across the region, including in Lebanon.
• The World Food Program and World Central Kitchen have both launched funds to rush food aid to those displaced by the conflict.

Many of these organizations are doing their best to actively deploy resources where they anticipate the greatest needs will be. “They don’t know how things are going to settle,” said McIlreavy. “They don’t know where they’re going to have access. And so they’re going to need to be flexible.” 

That goes for their supporters as well.

What about sending money to people directly?

The bulk of humanitarian aid still passes through established charities and agencies like the United Nations. But there’s also the increasingly popular idea of sending cash directly to people, something that has been done informally for centuries through remittances and mutual aid.

A growing body of research shows that even in fragile conflict zones, people often strongly prefer receiving cash — which they can then spend however they need to — over relief items like food parcels, hygiene kits, or blankets. The nonprofit GiveDirectly has pioneered the use of technology to get cash aid to people fast, and is actively exploring how to help those affected by this conflict through a newly launched emergency fund. 

Historically, most of GiveDirectly’s work has focused on people living in extreme poverty, rather than specifically targeting those living in conflict zones. But the organization has also more recently expanded to providing emergency relief to families affected by conflicts like the Yemeni civil war and armed clashes in the Democratic Republic of the Congo.   

One way the group works is through cellphone metadata, which can help identify people who are likely in need. In this case, that may include displaced people in Lebanon, Iranian refugees entering Turkey, or Malawians affected by rising fertilizer costs. GiveDirectly then screens those people for eligibility via text, and sends them cash through mobile payment platforms. 

The process tends to be “cleaner, faster, more objective, and cheaper” than more traditional outreach methods like knocking door-to-door, said Leith Baker, who runs GiveDirectly’s emergency cash strategy. It’s a “really protective, dignified way to receive money” that “gives the recipient a lot of choice and protection.”

Once the group’s outreach system is in place, it also works exceptionally fast, which makes it an especially promising option for people in rapidly evolving conflict zones. You can help GiveDirectly with its plans to send cash to those affected by the conflict by donating here.

For other ways to send cash directly, plenty of local advocates in Lebanon and across the region have also begun creating and sharing mutual aid funds for local families and organizations, like Nation Station, a volunteer-led community kitchen in Beirut, Lebanon. 

Helping people for the long haul

While those who live in range of the bombs are at the greatest risk, many of those most affected will include people who don’t live in the region at all. Those in already deeply impoverished countries will be the most vulnerable to the conflict’s economic ripple effects, which already include surging prices on food, fertilizer, and fuel. There are plenty of groups working to support communities in crisis both now and long after the news cycle fades.

• The Center for Disaster Philanthropy’s Global Recovery Fund directs funds to local organizations that need it most in the aftermath of both natural and manmade disasters.
• GiveDirectly has a standing fund to deliver emergency cash in the aftermath of disasters, as well as one for families facing extreme poverty more broadly. 
• Action Against Hunger works to fight hunger and build stronger food systems around the world, which could help make countries more resilient to price shocks.

Even prior to this escalating crisis, the world was already on the verge of a grim milestone. For the first time in decades, the number of people living in extreme poverty is projected to start increasing by 2030, with most of it highly concentrated in the poorest — and often most conflict-affected — countries. 

Global aid cuts have been making a bad situation even worse. And now, for the most vulnerable countries, the Iran war could cause far more than just higher prices at the grocery store, but also prolonged, widespread food shortages. It’s more important than ever to dig deep now to support those suffering the worst fallout.  

“Even if the conflict was to end tomorrow,” said McIlreavy, “the recovery will take a long time.”

Update, March 12, 1 pm ET: This story has been updated with information regarding the number of Iranian people who have been displaced by bombings.

Every great new discovery has to start somewhere. 

Penicillin was born out of moldy petri dishes followed by years of experimental testing. The Spice Girls started with an open audition, months of rehearsals in a shared house, and demo tapes stolen in the name of girl power.  When it comes to US foreign aid, the engine behind new discoveries tackling enormous global challenges was a tiny program called Development Innovation Ventures, or DIV.

Like the rest of the US Agency for International Development, DIV — which cost less than 12 cents per American per year to run — was dismantled within the first few months of the second Trump administration. Many vital projects, like a new low-cost, electricity-free respiratory kit for helping babies breathe, were cut off from support even as they “were moments away from the finish line,” said Sasha Gallant, who led DIV under USAID.

As broad swaths of global health architecture plunged into survival mode, the world also lost a cutting-edge clearinghouse for finding out what works and what doesn’t work in foreign aid. It was one of the only programs in the world laser-focused not only on saving people’s lives now, but also on learning how to save many more lives in the future. 

But now, one year later, DIV is back — and under new management. Instead of being an entity under USAID, former leaders have spun the program into a newly-formed independent nonprofit called the DIV Fund. Backed by private philanthropy, including a $45 million grant from Coefficient Giving, the slow and steady work of building a brighter future can continue. 

“It was hard to even think about innovation early in the year. It was like the house was on fire, and we’ve just got to get the kids out of the house,” said Gallant, who co-founded the new fund. But ultimately, “you also have to have better houses. We have to have better tools to extinguish the fires.”

For one possibility, look to Guatemala, where corn figures into almost every meal. DIV-backed program Semilla Nueva is literally seeding a new treatment for malnutrition by connecting local farmers with maize bred to contain higher levels of zinc, iron, and protein. There’s also Uganda — where Health Access Connect is building a fleet of motorcycle taxis to bring health professionals to remote villages — and Bangladesh, where the ARCED Foundation is fighting air pollution using data and satellite imagery.

DIV’s work differs from other NGOs that tend to fund solutions that are already standard practice, and only rarely invest in incubating and testing out brand new approaches. DIV supports organizations as they pilot and pressure test those projects to see if they really work in practice. If the evidence says they do, then — and only then — will DIV then help those organizations scale up. 

This model served DIV — and by extension, the world — very well during its 15-year stint at USAID. In 2021, a group of economists including Gallant and Nobel-winning cofounder Michael Kremer estimated that the $19.2 million DIV spent in its first three years generated $281 million in social benefits, which is a fancy way of saying that DIV helped an extraordinary number of people live longer, healthier, more prosperous lives. That wouldn’t have been possible without careful investments in research and development.

“People come to know the programs that are tremendously effective,” like investing in teachers, handing out malaria nets, or getting kids vaccinated, said Gallant. “But somebody had to figure out that those worked.”

As an independent nonprofit, the DIV Fund won’t have nearly as much money or resources as it did at USAID. This year, the fund will grant out about $25 million per year, just under half of what it could give before. You can help them overcome that gap by donating to their work here. 

But even so, DIV’s real potential has always come from punching above its weight, especially in moments when the good ideas it finds eventually catapult into the mainstream. Gallant said the fund’s ultimate goal is to continue connecting with partners — including philanthropists, national governments, and multilateral organizations — to ensure that innovation is “not just happening in an R&D shop” but rather “meaningfully influencing” decisions about where to steer funds in the real world. 

And if the US government ever comes knocking again, she says they’ll welcome it with open arms. The doors are “entirely open,” said Gallant, and “will remain open to any partner trying to think about how to integrate evidence-driven innovation into large-scale programming.”