Trump cuts HIV aid to Nigeria- A good thing

It is no longer news that President Trump, on assumption to office has unleashed a slew of executive orders. One of which is to cut US funding of the HIV program to African countries.

PEPFAR

PEPFAR which is the U.S. President’s Emergency Plan for AIDS Relief is the largest support by any nation to address HIV, funded by the US government. 

PEPFAR is run by the U.S. Department of State’s Office of the U.S. Global AIDS Coordinator and Health Diplomacy. PEPFAR shows the power of the US government to give effective and accountable care to millions living with HIV.

Since its inception in 2003, PEPFAR has invested over $100 billion in the global HIV/AIDS response. Some of its successes include:

• 25million lives saved
• 5.5 million babies born HIV free
• 20.47 million women, men, children on antiretroviral treatment
• 1.95 million people newly enrolled on pre-exposure prophylaxis to prevent HIV infection

Thus supporting several countries to achieve HIV control.
They have offices and work in more than 50 countries around the world including Angola, Burundi, Mozambique and Nigeria.

PEPFAR IN NIGERIA

Since 2003 Nigeria has benefited 6billion dollars from this program. The total budgets for PEPFAR for 2023/ 2024 for Nigeria was $782,186,330 (Over 1 trillion naira); Year 1 being$396,033,500 and Year 2 $386,152,830 inclusive of all new funding. The magnitude of this can only be seen when one compares this to Nigeria’s health budget for 2025 which is ₦2.48 trillion ( 5.18% of the total budget). A far cry from the 15% benchmark set by the Abuja Declaration in 2001. 

My first introduction to the PEPFAR program was as a house officer in one of our Military Hospitals in 2006. The program was fully in place and functional in the hospital with patients receiving free HIV medications and laboratory investigations. There were also special Nigerian PEPFAR doctors who we believe received allowances in dollars. The incidence of HIV was so high in that hospital that out of every 5 patients you saw, be rest assured one would be HIV Positive.

The high incidence of HIV cases in the hospital led to morbid fear of contracting the disease through needle pricks by the doctors. It got to a point that when house officers were faced with invasive procedures for the HIV patients, we would wonder why the PEPFAR doctors were not the ones being called.

I saw HIV positive patients that came in very ill being transformed to healthy individuals. This is a testament to the remarkable achievements of this program. No doubt the program would have evolved between then and now and would have seen various changes for good or for worse.

What will happen with the withdrawal of PEPFAR?

Nigeria has a significant HIV burden, being the fourth highest in the world.  

• The 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) estimated that 1.3% of people aged 15–49 had HIV. 
• A 2019 estimate showed that 1.8 million people were living with HIV. 
• Another estimate showed that 2.1% of people aged 15–49 had HIV. 

HIV prevalence by State 

• The South-South zone has the highest HIV prevalence.
• Benue state has the highest prevalence in the country.
• Jigawa state has the lowest prevalence in the country.

What has Nigeria been doing?

Under the Federal Ministry of health is The NASCP- National AIDS, Viral hepatitis and STI’s control program – whose duty is the prevention, treatment and support of HIV in Nigeria

The Federal government in 2001 initiated Nigeria’s National Antiretroviral (ART) Therapy Program. The aim being to place 10,000 adults and 5,000 children on treatment. The programme receives varied funding and has evolved over the years. It currently has about 1, 048, 805 people living with HIV on Antiretroviral therapy.

With the withdrawal of the PEPFAR program, millions of people will be stranded. They will have to move to any existing program for their free medications. This will place a significant burden on an already unstable healthcare system. It is now left to the Nigerian Government to rise up to the challenge posed.

Just like the book by Ryan Holiday, ‘The Obstacle is the way’. The spotlight must be turned back to health. There must be increased funding and judicious use of resources. Otherwise, we would have nothing less than a public health disaster on our hands.