It is early in the morning and the sun is already raging fierce. A group of men and women are seated on rickety chairs, their jovial faces looking uncharacteristically sad. Clouds of uncertainty are lurking everywhere with everyone afraid to ask what is on their minds: “Is this the end of the road for me?’
Potiskum, Nigeria – At an HIV clinic of a government hospital – the patients are all awaiting their turn to collect a six-month supply of antiretroviral therapy (ART). Without financial aid, the monthly cost of these medications could soar to approximately $4,500 per month for the hospital. However, thanks to contributions from international donors like the US president’s Emergency Plan for AIDS Relief (PEPFAR), the government procured these medications for less than $500 while the patients received them for free.
The future of this programme is now uncertain after the Trump administration recently decided to permanently slash more than 90 per cent of grants from the US Agency for International Development (USAID).
Earlier in January, President Trump signed an Executive Order halting USAID funding, although waivers were later issued to temporarily sustain critical humanitarian programs, including HIV initiatives. However, in many instances, these waivers were ineffective because the USAID staff responsible for processing payments had been dismissed. Some PEPFAR projects funded by the US Centers for Disease Control and Prevention (CDC) are currently protected by temporary waivers, but their future is also at risk once these waivers expire at the end of April. The reauthorisation of PEPFAR is set to be reviewed by the US Congress on March 25. Ghen Ghen Ghen.
The matron in charge of the clinic addresses the elephant in the room: “For now, we are giving out what we have in stock, but when the drugs run out, you may have to start paying.”
The people immediately start crying out. The educated ones start googling the prices of the drugs. They see an average of $100-$200 per month, depending on their drug combination and whether it is the first or second line of medication they are on.
N150,000 to N300,000 per month, every month for the rest of your life? There is problem fa!
Nigeria has the highest number of people living with HIV/AIDS in West and Central Africa and the fourth-highest globally. The country’s 1.4 per cent HIV prevalence in the adult population may appear low, but when you take into context the large population of more than 180 million people, it translates to about 1.9 million people living with HIV in Nigeria.
Despite recording a 13 per cent reduction in new HIV infection in the last 10 years, about 53,000 and 45,000 deaths were reported from HIV-related illnesses in 2018 and 2019 respectively. Data also indicate that Nigeria accounted for 2 of every 3 new HIV infections in West and Central Africa in 2023.
Let us look at northern Nigeria. Statistical reports from the National Agency for the Control of AIDS (NACA) show that HIV is particularly prevalent and spread rapidly among two key populations – commercial sex workers – young girls and men having sex.
Please do not come for my head; Inni Sa’imun.
People working in the HIV space know that this is an open-secret. As HIV is largely a sexually transmitted illness, it makes sense that many men and women contracted it through heterosexual and homosexual intercourse. We may choose to bury our heads in the sand, but the street children – both boys and girls – who continue to roam the land – often sexually exploited for financial gain, have grown up and now serve as reservoirs of infection. These men and women, in turn, are spreading the disease to others.
As if that is not enough, we are now witnessing more young men and women who were born with the disease (transmitted through pregnancy) and who have been on these medicines all their lives.
What will happen to them?
PEPFAR is the country’s largest HIV donor, supporting 9 per cent of Nigeria’s treatment burden. Over 81 per cent of Nigeria’s HIV spending comes from foreign donors. Its greatest contribution to Nigeria’s HIV response is in service delivery, where it has enhanced both prevention and care for those living with HIV.
While the limited PEPFAR waiver provided some reprieve in the fight against HIV, the inaccessibility of USAID’s payment system has caused delays in resuming distribution of foreign assistance. As a result, many of the life-saving humanitarian assistance programmes cleared to resume work are unable to do so.
At this HIV clinic, sometimes only one staff member from its PEPFAR-implementing partner showed up for work.
What will happen now that the money is gone? The answer is what we should have done more than 20 years ago. The answer is domestic funding.
The Nigerian government has not yet commented on whether the country has been impacted by the funding cuts (They are looking unto the Lord). However, in response to the executive orders, Nigeria has increased its focus on domestic initiatives to combat HIV as part of a broader strategy to mitigate the effects of the USAID funding freeze and potential shifts in foreign donor aid policies.
During the first meeting of the Federal Executive Council after the USAID freeze, Nigeria’s president formed a multi-stakeholder committee to oversee its transition away from reliance on donor funding for its HIV interventions. This is coupled with a $3.2 million allocation for 150,000 treatment packs to be distributed over the next four months.
The amount might seem meagre when you compare it to the amount spent by USAID, especially when you factor in corruption charges, but we have to start from somewhere.
The NACA has announced plans to begin domestic production of HIV commodities, including test kits and antiretroviral drugs by the end of 2025. Additionally, many states are making plans to enrol people living with the virus into the state’s insurance schemes so that the medicines can be purchased at a highly subsidised rate (10 per cent).
The good news is that the country has started making plans. Maybe, Trump’s administration might just be the wake-up call that Nigerians need.
For now, what I tell people is this: Nigeria has enough antiretroviral drug supplies to last until the end of the 90-day freeze and probably beyond. What happens after is up to God.
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