In January, US President Donald Trump halted the disbursement of funds from the President’s Emergency Plan for AIDS Relief (PEPFAR) for 90 days. This decision, which sent shockwaves through public health circles and international organizations alike, was in line with his campaign promise to prioritize American interests over global aid. The move has sparked significant concern in developing regions—especially Sub-Saharan Africa—where PEPFAR is a vital lifeline in the fight against HIV/AIDS.
For Nigeria, which has depended on PEPFAR support since 2005, the implications are particularly serious. With nearly 1.8 million Nigerians living with HIV, any interruption in funding could disrupt both treatment and prevention efforts. Many experts view this policy shift as a wake-up call for the country to reduce its reliance on foreign aid and to take greater ownership of its HIV response alongside other pressing public health needs.
Nigeria’s Swift Reaction
Within just two days of the directive, the Nigerian government announced measures to bolster its domestic HIV response—a move widely seen as a response to mounting public concern. Despite the US later granting a waiver for HIV interventions, Nigerian officials maintained their commitment to self-reliance. Through the National Agency for the Control of AIDS (NACA), plans were unveiled to begin local production of essential HIV-related tools, including test kits and antiretroviral drugs. Although these steps have been praised as proactive, some experts remain skeptical about Nigeria’s capacity to fully finance and sustain such initiatives on its own.
New Funding Initiatives
On February 3, the Federal Executive Council (FEC) approved $1.07 billion to support sweeping healthcare reforms under the Human Capital Opportunities for Prosperity and Equity (HOPE) programme. Additionally, N4.8 billion was earmarked specifically for HIV treatment, according to Finance Minister Wale Edun. In a further bid to close the funding gap, the Nigerian Senate recently allocated an extra N300 billion (approximately $200 million) in the 2025 budget, with these funds directed toward key health programmes including those for Tuberculosis, HIV, Malaria, and Polio.
Chronic Underfunding in the Health Sector
Nigeria’s health sector has long struggled with chronic underfunding. The country has repeatedly fallen short of the Abuja Declaration’s target for African nations to allocate at least 15 per cent of their annual budgets to health—instead, spending around five per cent on average. Even in 2024, when the sector received its highest-ever allocation, health spending amounted to just 5.75 per cent of the total budget. A large portion of these funds is absorbed by salaries and administrative costs, leaving limited resources for direct disease control and prevention. Over the past 11 years, about 72 per cent of the health budget has been devoted to workforce-related expenses, squeezing out much-needed investment in interventions such as HIV treatment and prevention. As a result, international donors, particularly through PEPFAR, have continued to play a critical role in funding Nigeria’s HIV/AIDS efforts.
Comparing PEPFAR and NACA Funding
Between 2015 and 2024, the US provided roughly $2.28 billion (equivalent to N3.4 trillion at an exchange rate of N1,493 per dollar) in HIV/AIDS assistance to Nigeria—a figure that accounted for about 53.21 per cent of the country’s total health budget during that period. In 2015, Nigeria received N292.63 billion in aid for HIV/AIDS, with subsequent years recording fluctuating amounts: N392.66 billion in 2016, N358.32 billion in 2017, N346.38 billion in 2018, N262.77 billion in 2019, peaking at N409.08 billion in 2020, then tapering to N306.07 billion in 2021, N370.26 billion in 2022, N341.90 billion in 2023, and N328.46 billion in 2024.
In contrast, Nigeria’s own funding for NACA has varied considerably. The agency received N2.78 billion in 2015, which increased to N3.42 billion in 2016, only to fall sharply to N738.49 million in 2017. Funding then picked up with N4.53 billion in 2018, N6.70 billion in 2019, a slight dip to N6.21 billion in 2020, followed by N4.51 billion in 2021, rising to N6.42 billion in 2022, N8.28 billion in 2023, and reaching N10.04 billion in 2024. For 2025, a proposed allocation of N19.03 billion has been tabled—the highest in recent years. Despite this upward trend, experts stress that Nigeria requires a more substantial and steady financial commitment to effectively combat HIV/AIDS.
Shifting Toward Domestic Ownership
The US, through PEPFAR, has long encouraged countries like Nigeria to gradually reduce dependency on external funding by promoting domestic ownership of HIV programmes. Between 2011 and 2015, PEPFAR reduced its annual support by about $83 million, shifting focus from emergency relief to long-term sustainability. However, studies and reports have shown that Nigeria struggled to replace this gap with domestic resources, leading to shortfalls in essential areas such as antiretroviral drug availability, testing services, and healthcare infrastructure. These funding gaps have resulted in treatment disruptions, stockouts of vital medications, and limited care access, particularly in rural and underserved communities.
Expert Perspectives on the Way Forward
Victor Adepoju, director of HIV, Viral Hepatitis, and Infectious Diseases at Jhpiego (an affiliate of Johns Hopkins University), argues that Nigeria will need to embrace a new funding model if PEPFAR support is fully withdrawn. Adepoju highlighted the recent creation of an integrated Technical Working Group (TWG) for HIV, TB, and Malaria as a positive development. He explained that previously, separate funding streams for each programme from Western donors were inefficient and costly. By integrating these efforts, Nigeria could reduce costs and improve overall efficiency. He also emphasized the potential benefits of locally producing TB, HIV, and malaria drugs to lower treatment costs, though he warned that the current national budget might still be insufficient to cover all needs. For example, while the government has recently approved procurement of HIV drugs for 150,000 individuals, over one million people depend on treatment—leaving many at risk if funding gaps persist.
Dan Onwujekwe, a former principal investigator at PEPFAR and research fellow at the Nigerian Institute of Medical Research (NIMR), recalled that international donor agencies had warned Nigeria as early as 2012 about preparing for a potential pullout. In interviews with local media, Onwujekwe noted that between 2012 and 2015, PEPFAR had engaged in multiple discussions with Nigerian health authorities to transition diagnostics, drugs, equipment, and infrastructure to domestic control. Despite these warnings, limited progress was made, resulting in current shortages of TB and HIV medications, particularly affecting older patients. He cautioned that a complete withdrawal of donor support could severely undermine Nigeria’s HIV/AIDS control efforts and urged immediate, coordinated government action. Onwujekwe suggested designating a specific tax revenue—such as a portion of stamp duty—to fund TB and HIV programmes, warning that failure to act could have catastrophic consequences for a country already facing one of the highest burdens of TB and HIV globally.
In summary, while Nigeria is taking steps to build a more self-reliant HIV response, the challenges of underfunding and the historical reliance on international aid underscore the need for a comprehensive, well-funded strategy to sustain progress in combating HIV/AIDS.
