As the U.S. Freezes Foreign Aid, Life-Saving HIV Programs in Nigeria Hang in the Balance

Update, January 31, 2025: The Trump administration has issued a waiver allowing PEPFAR to resume distributing H.I.V. medications, though the program’s long-term future remains unclear.

Nigerian women face a growing healthcare emergency as vital HIV testing services grind to a halt following a controversial flurry of recent U.S. federal funding moves.

On Tuesday night, Secretary of State Marco Rubio issued a waiver suspending a freeze on U.S. foreign aid for 90 days, following warnings from humanitarian groups that the halt in funding could put millions of lives at risk.

The pause comes just days after U.S. President Donald Trump ordered a freeze on all foreign assistance provided by the United States, the world’s largest aid donor. Trump had called for a comprehensive review to ensure aid programs aligned with his “America First” foreign policy agenda.

Despite the pause on the federal funding freeze, the impact of these moves could still be devastating in a country where women account for two-thirds of Nigeria’s 2 million HIV-positive individuals. The resulting suspension of PEPFAR, the biggest donor to HIV awareness, care, and research in Nigeria, has left millions of pregnant women without access to free testing, particularly in underserved rural areas.

As public hospitals worry over whether they still need to shutter their free testing programs, private facilities charging between 2,000 to 5,000 Nigerian naira ($1.25 - $3) per test have become the only option — an impossible sum for the 40 percent of Nigerians surviving on less than a dollar daily.

Femi Ojo, a healthcare worker based in Nasarawa State, was in his office when he received the news that HIV-related projects at his clinic were being suspended. For six years, Ojo and his team at Diadem Consults had been providing critical HIV testing and care, mostly for young girls, pregnant women, and adolescents. But after the U.S. government’s decision, Ojo’s clinic, along with about 1,400 others across the country, were instructed to not “incur new costs”as PEPFAR would no longer provide supplemental aid.

The effect of this was massive: no more community awareness and testing outreaches, no more free antiretrovirals, and no more pre- and post-exposure prophylaxis, leaving healthcare providers like Ojo scrambling to find ways to continue their work.

“We’re looking at a massive increase in mother-to-child HIV transmission if funding stops,” Ojo told More to Her Story. “Most of these women can barely afford the fares to the clinic to get free testing and drugs, not to talk of paying for these tests and drugs.”

For the past two decades, PEPFAR has been the backbone of Nigeria’s HIV response, investing approximately $7.8 billion to ensure that Nigerians living with HIV/AIDS receive treatment and care. According to Ojo, the program single-handedly reduced HIV prevalence rates in Nigeria by 6 percent, preventing countless deaths.

For Deborah Emmanuel’s mother, Vivian Emmanuel, who has been receiving antiretroviral treatment for the past five years at a clinic in Kaduna, the loss of funding could mean the difference between life and death. Deborah runs a small salon earning about 2,000 Nigerian naira ($1.25) daily while caring for her 46-year-old HIV-positive mother. Like 70 percent of Nigerian women in the workforce, she operates in the informal economy. Since 2019, her mother has depended on free treatment from the Kaduna clinic — care that has helped extend her life.

“No one expected her to live for this long, but she has been consistent with her medication and it has really worked,” Deborah told More to Her Story.

She is hopeful that the disruption will be fixed soon or that the Nigerian government will step in, because the alternative is simply not possible for her.

“She already has to pay about 1,500 Nigerian naira at the hospital whenever she goes to get new drugs, and sometimes we can’t even afford that,” Deborah said.

Nigeria’s maternal and child mortality rates are among the highest in the world, compounded by a weak healthcare system and widespread poverty. With women making up the majority of the nation’s poorest, they face an uphill battle in accessing consistent and high-quality care, particularly in rural areas. Many women in Nigeria do not have access to safe-sex education and discussing safe sex practices carries immense stigma in the country. This leaves them disproportionately exposed to HIV, and the loss of PEPFAR’s funding only heightens the risk.

Gatefield, a social advocacy organization based in Abuja, has paused its HIV awareness campaign as a result of the funding cut. The campaign, which was funded by PEPFAR, involved partnerships with women-focused publications like Marie Claire Nigeria, Femme Mag, and Document Women to direct young women to free HIV testing centers across Nigeria. Joy Una, Special Initiatives Lead at Gatefield, stressed the importance of government accountability in addressing the situation.

“There’s a lot of panic about the future of HIV and healthcare in general following the news,” she told More to Her Story.  “should be addressing the nation right now. We need to know what the government plans to do. If testing and treatment stop, we’re looking at chaos.”

On Wednesday, the U.S. government approved a waiver to keep granting access to critical care like HIV, yet Ojo says he’s no longer confident that they can keep operating at the scale they were at originally. As a stopgap, his clinic has offered patients six months worth of medication to combat the cost of transport.

For reproductive health advocates like Hafsatu Usman, co-founder of women’s reproductive health community The SARAH Project, the freeze has exposed just how reliant so many aid programs around the world are on U.S. foreign aid.

Indeed, Nigeria’s HIV programs are not alone in facing the curbs of aid freeze. Humanitarian organizations and UN agencies  worldwide are feeling the crush: In 2024, the U.S. supplied nearly $14 billion in global humanitarian aid supplying lifesaving resources — from refugee camps in Thailand to malaria clinics in Uganda, and beyond. 

Usman believes the crisis has exposed a deeper vulnerability in Nigeria’s healthcare system—its reliance on foreign aid, particularly when it comes to women’s health. She thinks that this moment should serve as a wake-up call for the government to take greater ownership of public health funding and infrastructure.

“I think we’ve seen now how much at the mercy of countries like the United States our healthcare systems are, and that has raised serious questions about our government and what we can do to advocate for our own independent healthcare systems.”