Written by Bernard Otu
“Is this how I am going to die?” Seventeen-year-old Nafisat whispered those words after being turned away from the clinic today. She had tested positive for HIV in October after surviving sexual violence. Treatment had been her lifeline—until now. When she went for her routine drug refill, she was met with a devastating response: “There are orders to stop disbursement.”
Following his inauguration for a second term as President of the United States on Monday, January 20, 2025, Donald Trump has signed several executive orders, some of which pose grave concerns for global health. Among these, the decision to withdraw the US from the World Health Organization (WHO) and the stop work order for all global health funding, including PEPFAR (U.S. President’s Emergency Plan for AIDS Relief) by extension distribution of medication within the US and across partner countries stand out as actions with far-reaching consequences. This decision threatens to derail the global movement towards achieving an end to AIDS by 2030.
The implications for Nigeria’s HIV response are particularly dire. Over the years, Nigeria has relied significantly on US funding for healthcare programs, particularly in the provision of Sexual and Reproductive Health and Rights (SRHR) services, HIV commodities, and treatment programs. PEPFAR (the US President’s Emergency Plan for AIDS Relief) has been instrumental in ensuring access to antiretroviral therapy (ART), prevention programs, and overall healthcare infrastructure. With the sudden halt of these funds, Nigeria is now facing a potential crisis that could lead to a resurgence of HIV infections and AIDS-related deaths.
The immediate effect of this funding pause is already evident in the disruption of drug disbursements, with many HIV-positive Nigerians struggling to access life-saving medication. The situation is further exacerbated by the pharmaceutical crisis Nigeria has faced since 2023 when major pharmaceutical companies pulled out due to economic instability, leading to skyrocketing drug prices. For a country where the minimum wage remains at a mere 30,000 naira—recently reviewed but yet to be implemented across some states and sectors—this presents an insurmountable challenge for many individuals who depend on free or subsidized healthcare services.
Beyond individual health outcomes, this disruption could have broader public health consequences. With inconsistent access to ARV, there is an increased risk of drug resistance, which could lead to the emergence of a new strain of HIV. This could escalate into another global pandemic if not adequately contained. The situation paints a grim picture of Nigeria’s vulnerability due to its heavy reliance on external funding and foreign aid for critical healthcare interventions.
Additionally, the shortage or possible withdrawal of funding could lead to the deterioration of healthcare infrastructure, the discontinuation of community-based interventions, and reduced outreach to vulnerable populations, particularly women and girls who rely on these services the most. With fewer organizations able to sustain operations, the burden will shift to the Nigerian government, which has historically underfunded healthcare.
Nigeria must recognize this crisis as a wake-up call to prioritize self-reliance in healthcare financing. While external aid has been beneficial, our heavy dependence on it has left us vulnerable to the policy shifts of foreign governments. The reality is that we have not invested adequately in our healthcare system. Instead, extravagant spending on non-essential government projects continues while healthcare, education, and other critical sectors suffer.
The Nigerian government must take urgent steps to bridge this funding gap and safeguard the country’s HIV response. First, increasing budgetary allocation for healthcare is crucial. Despite the Abuja Declaration’s recommendation that 15% of national expenditure be dedicated to health, Nigeria’s investment remains alarmingly low. Without a stronger financial commitment, sustaining progress in HIV treatment and prevention will be impossible. Additionally, revitalizing the pharmaceutical industry is essential. The exit of major pharmaceutical companies has deepened Nigeria’s healthcare crisis, making life-saving drugs scarce and unaffordable. The government must foster a favorable business environment for local pharmaceutical companies to thrive, ensuring a stable and affordable supply of HIV medications.
Beyond this, exploring alternative funding mechanisms such as public-private partnerships (PPPs), health insurance schemes, and innovative financing strategies will help reduce Nigeria’s overreliance on foreign aid. Lastly, strengthening civil society and community-led responses is key. CSOs play a vital role in healthcare service delivery, advocacy, and policy influence. The government must engage them as strategic partners and establish policies that enable their continued work, ensuring that HIV services remain accessible and inclusive, regardless of external funding shifts.
The cuts and possible withdrawal of US funding is a harsh reminder that Nigeria cannot continue to depend on international donors to sustain its healthcare system. While advocacy efforts should continue at the global level to push for the reinstatement of funding and support, Nigeria must take immediate and strategic action to mitigate the impact of this crisis. Our healthcare system’s sustainability hinges on deliberate policy shifts, increased local investments, and a commitment to prioritizing public health over political excesses.
Thanks to global efforts, the decision to pause funding and all programme activities was reconsidered, and priority given to disbursing ARVs to people living with HIV, but still Nafisat, is yet to get her drugs refill and its been over 13 days since her last drugs. If we fail to act now, we risk not only reversing decades of progress in the fight against HIV/AIDS but also exposing our population to a potential new wave of the epidemic.
The time for self-sufficiency is now!!!
Education as a Vaccine (EVA) 
