On a warm evening in Johannesburg, the news spread like wildfire among sex workers: Within 24 hours, several nonprofit clinics providing free HIV services would be closing as President Donald Trump announced the United States was slashing foreign aid.

Some South Africans living with, or at risk of, HIV secured supplies of life-saving drugs just in time. Others did not.

Half a year later, the country with more people living with HIV than any other is struggling to treat its most vulnerable. Over 63,000 people were being treated in the 12 clinics across the nation that shut down. Up to 220,000 people have faced disruption to their daily HIV medication.

South Africa's government has vowed it won't let the U.S. withdrawal of about $427 million in support collapse its HIV program, the largest in the world.

Sex workers, among the most vulnerable South Africans as their work is illegal, and transgender people spoke to The Associated Press on condition of anonymity for fear of retaliation from families or communities. They described a new world of difficulty in obtaining HIV medication or the preventive medicine for people at risk of HIV.

One HIV-positive sex worker and mother of three said she was off medication for almost four months after being turned away from public hospitals, which the government's health department says should not be happening.

“The only thing that I could think of was my kids, and that I am going to die, and how am I going to explain to my kids that I am sick because of the line of work that I chose?” she said. The 37-year-old said she finally obtained a month’s supply of medication in June from a mobile clinic that was introduced after the funding cuts. She didn’t know what she would do after that.

Another HIV-positive sex worker said she had resorted to illegally buying medication on the black market, where the pills have nearly doubled in price.

The U.S. has since issued a limited waiver allowing the resumption of certain life-saving HIV services globally, but the dismantling of much of U.S. foreign aid has created chaos. And for many people affected, harm is already done.

Overall, experts warn of hundreds of thousands of new infections in the next few years in South Africa, and tens of thousands of additional deaths, if the cuts in aid aren’t restored or covered by other means.