By Comfort Asemota
Funding reductions by the United States Government are taking a heavy toll on Nigeria’s HIV response, leading to acute shortages of HIV test kits in public hospitals and clinics nationwide. The scarcity persists despite repeated assurances from the Federal Government to increase domestic funding and its pledge to end AIDS as a public health threat by 2030.
When Danladi Adamu woke up on January 20, 2025, he had no idea that a single announcement would hit him so hard. That morning, news broke that the United States Government had paused all foreign assistance, immediately threatening the flow of life-saving HIV medicines and treatment to countries including Nigeria.
Living with HIV for over 25 years, Adamu described the news as a devastating blow. “Those of us who follow the news closely rushed to our treatment centres immediately to confirm if the report was true,” he recalled. “Many of us went even though it wasn’t our appointment day, hoping to get extra medication before things got worse.”
The announcement caused widespread psychological distress among people living with HIV (PLHIV). “The announcement brought a lot of psychological trauma to us. We are still trying to recover,” Adamu said. While he and others continued to access their medications, the scarcity of test kits soon became the major challenge, revealing the stark impact of funding cuts.
Abdullahi Ibrahim, Bauchi State coordinator for the Network of Persons Living with HIV/AIDS (NEPWHAN), confirmed that while antiretroviral treatments (ARTs) remain stable, testing kits are inadequate. “We ran out of test kits in November, and they are still unavailable this month,” he said. He explained that the shortage has slowed community testing efforts, hampering progress toward the global 95-95-95 target to end AIDS by 2030.
“If test kits are unavailable, the goal of 95 percent of the population knowing their HIV status will not be achieved. Many people may unknowingly spread the virus,” Ibrahim said. Currently, HIV testing in Bauchi is largely limited to pregnant women, leaving a gap in the general population.
Impact Across Nigeria
Shortages are not limited to Bauchi. TB/HIV specialist Dr. Dan Onwujekwe highlighted that HIV testing is the entry point to care. “If testing kits are unavailable, particularly free ones, identifying those living with HIV becomes a major problem. This can lead to further transmission and difficulty controlling the epidemic.”
The funding cuts began after the January 20 announcement, which disrupted programs including testing, counseling, education, and community support. These programs have historically relied heavily on international donors, particularly the US President’s Emergency Plan for AIDS Relief (PEPFAR), which has saved millions of lives globally since 2003.
UNAIDS warns that discontinuation of HIV programs could result in millions of new infections and AIDS-related deaths globally. In Nigeria, an estimated two million people are living with HIV, including a vulnerable population of children. Experts say that the funding cuts risk undermining progress toward the 95-95-95 global goal, which aims for 95 percent of people to know their HIV status, 95 percent of those diagnosed to receive sustained ART, and 95 percent of those on treatment to achieve viral suppression.
Federal Government Interventions
Since the funding reductions, the Federal Government of Nigeria, through the National Agency for the Control of AIDS (NACA), approved a $200 million intervention fund to bridge the funding gap. The government also established the Presidential Initiative for Unlocking the Healthcare Value Chain to boost domestic production of ARVs and diagnostic test kits.
While PLHIV continue to have access to life-saving medications, shortages persist for test kits, second- and third-line drugs, and pediatric ARTs. The fear of additional donor withdrawals has caused ongoing anxiety among PLHIV, with concerns that local programs may not match the quality previously provided by international partners.
UNICEF has warned that without urgent action, millions of children are at risk of HIV-related deaths. Recent modeling suggests that reduced program coverage could lead to over three million infections and nearly two million deaths among children by 2040.
Regional Challenges
In the South-East, states such as Enugu and Anambra face inadequate test kits. Amaka Adindu, a PLHIV in Anambra, described how drug supplies were reduced and care workers paid by donors stopped working, leading to significant hardship. Currently, only limited test kits are available for patients visiting facilities.
In Rivers State, test kit shortages prevent community engagement, leaving many unaware of their HIV status. In Jigawa, shortages extend to pediatric ARTs, with fears that funding cuts could undermine program sustainability. In the Federal Capital Territory, second- and third-line ARTs are increasingly difficult to access, leaving patients on failing regimens for longer and risking drug resistance.
In the North-East, outreach activities have been reduced due to lack of funding, affecting care delivery even when ARTs and test kits are available. The South-West has a mixed response, with Oyo State experiencing major service disruptions in early 2025, although ART supply has stabilized; test kits remain insufficient. Lagos State shows a more positive outcome, with ART and test kits available, and the state government has expanded PrEP access for all residents.
Expert Calls for Local Solutions
HIV and TB experts stress the urgent need for domestic solutions. Prof. Lawrence Ogbonnaya, a researcher at Ebonyi State University, said testing remains the first critical step in controlling HIV, and funding gaps threaten progress. Dr. Dan Onwujekwe emphasized that Nigeria must reduce reliance on imported test kits and ARVs, calling for local manufacturing to ensure sustainable HIV response.
Conclusion
The funding crisis highlights Nigeria’s vulnerability to external aid and underscores the need for sustainable domestic solutions. While ART availability remains relatively stable, shortages of HIV test kits, pediatric drugs, and second- and third-line treatments, combined with reduced outreach, continue to threaten the country’s efforts to end AIDS by 2030. Experts and PLHIV advocates stress that local production, consistent funding, and holistic care approaches are essential to maintaining progress in the fight against HIV.
