For more than twenty years, donor-backed programmes have been the cornerstone of HIV care in Nigeria, providing millions of people with free antiretroviral drugs, testing, and support services. These initiatives have kept countless lives stable and helped contain the epidemic. However, recent global funding disruptions are eroding this safety net, quietly reshaping lives and threatening decades of progress in the fight against HIV.
Bunmi Awotuyi, a 48-year-old caterer who tested positive for HIV in 2010, recounts how she initially relied on a robust support system at the Nigerian Institute of Medical Research in Lagos. Over time, that sense of security diminished due to global funding interruptions. In January, a 90-day suspension of foreign aid approved by the U.S. government halted funds through USAID, affecting programs under PEPFAR and the Global Fund, though a waiver allowed lifesaving medicines to continue temporarily. Despite the waiver, service delivery suffered as implementing partners struggled to maintain operations, leaving patients anxious about access to medications and support.
The disruptions led to rationing and brief pauses in antiretroviral drug distribution. Patients reported receiving smaller drug supplies and, in some cases, sharing medications with others. Rising costs for consultations, transport, and drug collection have created additional barriers, making access to treatment increasingly difficult for patients who previously relied on free services. These challenges are compounded by the fact that patient records are tied to specific facilities, limiting options for relocating care.
UNAIDS has warned of the global consequences of such funding gaps, highlighting increased deaths, loss of prevention services, and closures of community-led organisations. In Nigeria, more than two million people living with HIV are at risk of treatment disruption. In response, the Federal Government approved N4.8 billion for 150,000 HIV treatment packs and established an inter-ministerial committee to develop a long-term sustainable financing plan. However, experts caution that the funding is insufficient to meet the scale of the crisis, especially as Nigeria records nearly 191,000 new HIV infections annually.
The funding crisis has had far-reaching effects on health workers and programme staff. Nearly half of ad-hoc HIV programme staff lost their jobs, forcing remaining workers to cover multiple roles under extreme pressure. Mentor mothers, who support pregnant women living with HIV, have faced salary reductions and increased workloads while striving to prevent mother-to-child transmission. Patients report difficulties adhering to therapy due to rising costs, lack of transport, and disrupted services, sometimes turning to unsafe alternatives or delaying treatment, which has resulted in increased viral loads and preventable health complications.
Support services previously offered by community-based organisations—such as nutrition assistance, transport stipends, and outreach—have largely collapsed, leaving many patients without the necessary care to maintain viral suppression. Health experts warn that interruptions in treatment not only threaten individual health but also increase the risk of HIV transmission within the community. Despite Nigeria’s measurable progress toward the UNAIDS 95-95-95 targets, significant gaps remain, particularly for children, adolescents, and vulnerable populations.
Researchers and practitioners stress that Nigeria’s heavy reliance on foreign aid left the country unprepared for the funding shortfalls. Experts call for urgent mobilization of resources to sustain HIV care, protect patients, and support community-based organisations that provide critical services. Without immediate and adequate intervention, the health and lives of millions of Nigerians living with HIV are at serious risk.
