Trumps hammer on PEPFAR funds: Consequences for Nigeria health security
When Donald Trump was inaugurated as President of the United States on 20th January, 2025, one of the first thing he did was to put the PEPFAR programme on halt and took PEPFAR’s computer systems offline.
PEPFAR is the United States President’s Emergency Plan for AIDS Relief. It is the global health funding by the United States to address the global HIV/AIDS epidemic and help save the lives of those suffering from the disease. The U.S. allocation of over $110 billion marks the largest investment any country has ever made toward combating a single disease. As of 2023, PEPFAR has saved over 25 million lives, primarily in sub-Saharan Africa. As at May 2020, PEPFAR had provided cumulative funding for HIV/AIDS treatment, prevention, and research since its inception, making it the largest global health program focused on a single disease in history until the COVID-19 pandemic.
PEPFAR is implemented by a combination of U.S. government agencies in over 50 countries and overseen by the Global AIDS Coordinator at the United States Department of State. The PEPFAR program has in recent years been criticised by members of the Republican Party who have sought to block its re-authorization. So on 20th January, 2025, the Donald Trump administration, pull the plug. President Trump signed an executive order initiating the United States’ withdrawal from the World Health Organisation (WHO). Followed with a funding freeze on global health programmes, including those funded by PEPFAR. The U.S. State Department announced a comprehensive freeze on new funding for most foreign aid programs worldwide, excluding emergency food aid and military assistance to Israel and Egypt. This suspension affects billions of dollars allocated for health, education, development, and other aid initiatives, with no exemptions for critical health programmes like PEPFAR.
Humanitarian organizations have expressed alarm, noting that the freeze could halt many U.S. funded projects in health and other sectors. The International AIDS Society (IAS), has warned that the immediate halting of funding to PEPFAR, including a stop-work order for existing grants and contracts, places millions of lives in jeopardy. More than 20 million people living with HIV globally, including 550,000 children under 15, depend on daily services provided with support from the PEPFAR program. These actions have led to widespread concern among global health experts and organisations about the future of HIV/AIDS programmes and the potential reversal of progress made in combating the epidemic.
When PEPFAR was signed into law 15 low- income countries with high HIV/AIDS prevalence rates, were designated to receive the majority of the funding. The 15 countries were Botswana, Côte d’Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Rwanda, South Africa, Tanzania, Uganda, Vietnam, Zambia and Nigeria. Although the Trump administration on January 28th, 2025, granted a waiver for essential medicines and medical services, temporarily restoring a global HIV treatment programme that had been suspended, it remained unclear whether the exemption covered preventive drugs or additional services provided through the
PEPFAR.
HIV in Nigeria is a significant public health concern with an estimated 1.9 million people living with the virus. According to reports, Nigeria has the world’s second highest number of people living with HIV, with 190,950 HIV/AIDS infections per year. The adult HIV prevalence rate is 1.3%, with women being more likely to be affected than men (1.6% vs 1%). Young women aged 20-24 are more than three times as likely to be living with HIV as young men in the same age group. Let’s take a look at these key statistics: New HIV Infections in 2021 was 74,000, same year, AIDS-related deaths 51,000 while people on Antiretroviral Treatment is 1.7 million people.
Nigeria has made progress in scaling up HIV treatment and prevention services, with a significant increase in the number of people on antiretroviral therapy (ART). However, there are challenges despite PEPFAR intervention. Some of these challenges include: Limited access to treatment logistical challenges due to the large population and geographical spread of Nigeria which pose logistical challenges for HIV programming. You can imagine the rate the virus will spread if funds like PEPFAR is cut off. If HIV is not treated, almost everyone affected will develop AIDS. And if everyone who has HIV develop AIDS, it will spread like wildlife. To treat HIV, ART drugs is needed (these are the drugs provided by PEPFAR over the years) and these drugs have become so effective that a HIV positive person can no longer transmit the virus if the level of the virus is suppressed.
The problem, however, is that these drugs are expensive, and are donated to countries like Nigeria. If Trump cuts this donation, your guess is as good as mine. The ripple effect will be better imagined than experienced. Nigeria needs to take charge and nip this pending crisis in the bud before it gets out of hand. Nigeria has so many challenges, that is has no room to accommodate the crisis this withdrawal will create. No doubt, the Nigerian government has established various initiatives to address the HIV epidemic, including the National Agency for the Control of AIDS (NACA) and the Presidential AIDS Commission, International partners, such as UNAIDS and the Global Fund, also provide support for HIV programming in Nigeria. These efforts have to be doubled, if it wants to checkmate the impending doom. With the population of Nigeria, the sexually active population is high. The youths in Nigeria account for 32.0% of Nigerian’s 140 million people and nearly half (48.6%) of adolescents aged 15-19 are sexually active. About one in five of sexually active females and one in 12 sexually active males had already engaged in sexual intercourse by the age of 15. Findings from National AIDS and Reproductive Health Survey, shows that the median age of sexual debut among youths is 17years in females and 21years in males. A common feature of young people in Nigeria is their potential vulnerability to Sexually Transmitted Infections (STI) including HIV.
Nigerian government will need to start strategising on how to make the ARV drugs available for its affected persons. Subsidising is not an option. A look at President Bola Tinubu’s 2025 Nigeria budget allocates ₦2.48 trillion to the health sector. Some key health-related initiatives in the 2025 budget include: Infrastructure Development: ₦402 billion allocated for infrastructure investments in the health sector, Basic Health Care Fund: ₦282.65 billion allocated to support the fund. These allocations demonstrate the administration’s commitment to improving healthcare services and outcomes in Nigeria. I do not know if HIV/AIDS has a place in this budget. It is time for Nigerian government to own its health system and take it seriously. We cannot continue to depend on donations for our own healthcare. Let’s not forget that Trump’s hammer is also on Malaria and Tuberculosis.
