Donald Trump, the US president, has ordered the suspension of PEPFAR — the President’s Emergency Plan for AIDS Relief — and Nigeria faces the threat of losing $390 million in annual HIV/AIDS funding the Federal Government never planned for.
On Friday, the US State Department enforced Trump’s January 20 executive order, pausing nearly all US foreign assistance for at least 90 days, with exceptions limited to emergency humanitarian aid and military support for Israel and Egypt.
PEPFAR’s annual $6.5 billion budget has been a lifeline for over 20.6 million people globally, funding life-saving medication, testing and education, according to the United States Agency for International Development (USAID).
Since its creation in 2004, PEPFAR has saved an estimated 26 million lives, according to the US State Department. However, the programme’s suspension poses a particular challenge for Nigeria, a country heavily reliant on PEPFAR for HIV interventions.
PEPFAR’s ROLE IN HIV RESPONSE
Between its inception in 2004 and 2023, PEPFAR contributed $7.8 billion to Nigeria’s HIV response through organisations like the National Agency for the Control of AIDS (NACA), according to the United States Embassy in Nigeria.
The funding pattern suggests that the relief programme has been the largest contributor to HIV management efforts in Nigeria since its inception in 2004.
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Already, NACA rates PEPFAR together with the Global Fund, another foreign aid largely funded by the United States, as the two largest donors to HIV response efforts in Nigeria.
Between 2004 and 2018, the programme provided nearly $6 billion in funding to Nigeria. The second largest funder, the Global Fund only contributed $28.6 million during the same period, according to a 2022 NACA and UNAIDs publication.
According to the same report, Nigeria went from solely funding HIV response efforts before 2004 to relying solely on international donors between that time and 2024.
International sources like PEPFAR accounted for up to 92% of total HIV programme funding between 2007 and 2018, while the government contributed between 7.6% and 27.1%. Contributions from the private sector were almost negligible, ranging between 0% and 2.1%.
In its first year, the programme procured antiretroviral drugs (ARVs) for 25,000 people and scaled up treatment services in 54 locations.
Over time, it expanded access to over 500 ARV sites and 600 prevention-of-mother-to-child-transmission (PMTCT) outlets, providing care and support to tens of thousands in Nigeria.
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MAJOR PEPFAR INTERVENTIONS IN HIV RESPONSE IN NIGERIA
In 2004, PEPFAR provided over $70 million to support a comprehensive HIV programme in Nigeria. This represented the largest investment by any government for the containment of a single disease at the time.
By 2005, PEPFAR had committed an additional $113.4 million to bolster Nigeria’s HIV response efforts.
In 2018, the Nigeria AIDS Indicator and Impact Survey (NAIIS), the world’s largest HIV survey, was launched by President Muhammadu Buhari. The initiative received $100 million in financial support from PEPFAR and the Global Fund.
The suspension of PEPFAR would leave a $390 million funding gap in HIV response efforts in Nigeria, on an annual average.
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HIV BURDEN IN NIGERIA
Despite some progress, Nigeria remains a hotspot for HIV/AIDS. Approximately 1.8 million people in the country rely on treatment to survive, according to the Nigeria HIV/AIDS Indicator and Impact Survey.
HIV prevalence is notably higher among women (1.9%) than men (1.1%), with young adults aged 20 to 24 showing a stark gender disparity — 1.3% of women are infected compared to just 0.4% of men.
About 90,000 children in Nigeria live with HIV, and over 15,000 are born with the virus each year due to gaps in prevention services.
BROADER IMPLICATIONS
PEPFAR’s suspension is compounded by the Trump administration’s decision to withdraw funding from the World Health Organisation (WHO).
Nigeria previously received about $100 million in WHO-backed support between 2016 and 2024, averaging $11 million annually. The loss of both PEPFAR and WHO funding adds immense pressure to Nigeria’s underfunded health sector.
In 2024, Nigeria allocated just 5.46% of its national budget to healthcare, falling short of the 15% benchmark set by the Abuja Declaration. This amounts to roughly $9 per Nigerian annually, a far cry from the resources needed to combat a public health crisis of this magnitude.
— FIJ
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