By Pharm. Samuel Ewelike
Nigeria, Africa’s most populous nation, is facing a critical juncture in its fight against HIV/AIDS. With an estimated 1.9 to 2 million people living with HIV, the country has made significant strides in reducing HIV prevalence from 2.8 percent in 2018 to 1.3 percent in 2023. However, recent policy shifts by the United States, particularly the suspension of funding through the President’s Emergency Plan for AIDS Relief (PEPFAR), have thrown Nigeria’s HIV/AIDS management into disarray. This article critically analyses the current trends, implications, and potential pathways forward, offering a comprehensive perspective on how Nigeria can navigate this crisis and ensure sustainable healthcare solutions for its citizens.
Current Trends in HIV Drug Access
Domestic Funding Boost
In response to the suspension of PEPFAR funding, which previously covered approximately 80 percent of Nigeria’s HIV programmes, the Nigerian government allocated ₦5 billion (approximately $3.2 million) to procure 150,000 HIV treatment packs over four months. This initiative aims to safeguard access to antiretroviral therapy (ART) for 1.8 million Nigerians living with HIV. While this is a commendable step, it is a drop in the ocean compared to the scale of the problem. The ₦5 billion allocation covers less than 10 percent of the total patient population, leaving the majority vulnerable to treatment interruptions.
Treatment Interruptions
Despite the government’s efforts, clinics in high-prevalence states like Benue have reported indefinite closures of HIV services, particularly for key populations such as men who have sex with men (MSM) and transgender individuals. ART refills, pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP) services have been halted, leaving patients in limbo. This disruption not only jeopardises individual health outcomes but also risks reversing the progress made in reducing HIV transmission rates.
Implications of U.S. Policy Shifts
Immediate Crisis
The suspension of PEPFAR funding poses an immediate threat to Nigeria’s HIV/AIDS management. PEPFAR has been instrumental in reducing HIV prevalence and mortality rates in Nigeria, providing critical support for ART, viral load monitoring, and prevention programs. Without this funding, an estimated 1.7 million Nigerians on ART risk losing access to life-saving medications. The World Health Organisation (WHO) has warned that such disruptions could lead to a resurgence of HIV-related deaths and new infections, both in Nigeria and globally.
Research Disruption
U.S.-funded HIV/AIDS and malaria research at Nigerian universities has also stalled, delaying innovations in prevention and treatment. This setback not only affects current patients but also hampers Nigeria’s ability to develop homegrown solutions to the HIV crisis.
Economic Burden
The cost of ART, which ranges from $100 to $1,000 ( #150,000 to #1.500,000) per month, is unaffordable for most Nigerians, particularly in a country where unemployment and poverty rates are high. The suspension of PEPFAR funding exacerbates this economic burden, forcing many patients to choose between treatment and other necessities.
Effects on HIV Patients in Nigeria
Treatment Gaps
Patients like Stephen Enoch in Lagos face an uncertain future, fearing treatment lapses due to funding cuts. Key populations in states like Benue are already experiencing service blackouts, risking viral rebound and increased transmission rates. Treatment interruptions not only endanger individual lives but also undermine public health efforts to control the epidemic.
Stigma and Inequality
Marginalised groups, including sex workers, MSM, and transgender individuals, are disproportionately affected by the suspension of PEPFAR funding. Many of these individuals rely on specialised clinics, such as One Stop Shops, which provide stigma-free environments and tailored services. With these facilities shuttered, patients are forced to seek care in mainstream healthcare settings, where they often face discrimination and inadequate care.
Proposed Innovative Solutions
Emergency Distribution
The Nigerian government must accelerate the disbursement of the ₦5 billion emergency fund to reopen clinics and restore ART access, particularly in high-burden states like Benue and Rivers. Prioritising key populations and ensuring equitable distribution of resources is critical to mitigating the immediate crisis.
Anti-Corruption Measures
Transparent tracking systems for HIV funds must be implemented to prevent misappropriation and ensure that resources reach those in need. Corruption has long plagued Nigeria’s healthcare system, and addressing this issue is essential for building trust and ensuring effective service delivery.
Local Generic Production
Investing in Nigeria’s pharmaceutical industry to produce generic ARVs locally could significantly reduce dependency on imported drugs and lower treatment costs. Initiatives like the AIDS Healthcare Foundation (AHF) campaigns for local production of generics should be scaled up to ensure long-term sustainability.
Community-Based ART Delivery Models
Community-based models, such as on-site initiation and decentralised refill systems, have shown promise in improving treatment uptake and adherence. Programmes like SIDHAS, which supports 2,684 community ART refill structures, demonstrate the potential of these approaches to reach underserved populations.
Differentiated Service Delivery (DSD)
Pharmacy-led ART distribution and tailored services for key populations can decongest health facilities and improve access to care. For example, River State’s partnership with local pharmacies to dispense ARVs has been successful and could be replicated in other high-burden regions.
Long-Acting HIV Medications
Emerging therapies like monthly injectable PrEP or ART (e.g., cabotegravir) could mitigate adherence challenges, particularly for mobile populations. Advocacy for cost-reduction strategies and local production of these therapies is essential to making them accessible to Nigerians.
Technology-Driven Solutions
Mobile testing units and electronic health records (EHRs) can enhance the scalability and efficiency of HIV programs. AHF Nigeria’s decentralised clinics and community campaigns have tested over 2.5 million people, demonstrating the potential of technology-driven solutions to bridge the treatment gap.
The Way Forward
Nigeria’s response to the HIV/AIDS crisis highlights both resilience and systemic fragility. While short-term fixes provide relief, long-term success hinges on reducing aid dependency, combating corruption, and centering equity in healthcare delivery. The following steps are critical to ensuring sustainable progress:
Sustainable Financing: Nigeria must secure domestic funding through mechanisms like health taxes and diversify partnerships with organizations like the Global Fund. A multi-ministerial committee should be established to oversee these efforts and ensure accountability.
Community-Led Solutions: Scaling up initiatives like the HIV Prevention 2025 Roadmap, which emphasizes prevention for key populations and integrates HIV services with primary healthcare, is essential for achieving epidemic control.
Global Advocacy: Nigeria must leverage diplomatic channels and global health networks to pressure the U.S. to exempt PEPFAR from funding freezes. Restoring PEPFAR funding is critical to maintaining the gains made in HIV/AIDS management.
Integration of Services: Combining ART distribution with maternal health or tuberculosis (TB) programs can reduce clinic visits and improve access to care. Integrating HIV services into primary healthcare systems is key to building resilience against future shocks.
Conclusion: A Path to Resilience and Equity
Nigeria’s HIV/AIDS crisis is a stark reminder of the interconnectedness of global health and the fragility of progress in the face of external shocks. While the suspension of PEPFAR funding has created significant challenges, it also presents an opportunity for Nigeria to reimagine its approach to healthcare delivery. By prioritizing community-driven models, investing in local production, and advocating for sustainable financing, Nigeria can mitigate the impact of funding cuts and build a more resilient healthcare system.
The road ahead is fraught with challenges, but with concerted effort and unwavering commitment, Nigeria can turn this crisis into a catalyst for change. The lives of millions of Nigerians depend on the actions taken today. It is not just a matter of public health but a moral imperative to ensure that no one is left behind in the fight against HIV/AIDS.
Samuel Ewelike. B.Pharm.MPH, is public health researcher, global health advocate, and student at the University of New Haven, Connecticut, USA. Samuelewelike@gmail.com
