“I Need My ARV Daily:” Trump’s PEPFAR Freeze Threatens HIV Care in Nigeria
The suspension of the U.S. AIDS Relief Program throws HIV treatment into disarray, leaving millions vulnerable as clinics shutter and vital services halt.
The funding suspension has already halted field testing, economic empowerment programs, and lab services.
"If people don't have access to prevention services, it means they'll be unable to protect themselves from HIV and other sexually transmitted infections," says Ebube Kenechukwu, a 25-year-old Nigerian man who relies on Cabotegravir, an injectable form of PrEP (pre-exposure prophylaxis). "I was supposed to go in for my next injection in March, but now I have to wait until April," he tells OkayAfrica.
Kenechukwu is one of the millions of Africans whose health care has been disrupted by President Donald Trump's executive order on Sunday, Jan 26, which paused all U.S. foreign development assistance for 90 days,including the President's Emergency Plan for AIDS Relief (PEPFAR). The order triggered an immediate halt to HIV medication distribution in Africa, throwing critical treatment programs into disarray.
This decision comes on the heels of Trump's executive order to withdraw the United States from the World Health Organization (WHO), which requires a 12-month notice period andcould further destabilize healthcare access across Africa.
While U.S. Secretary of State Marco Rubioapproved an emergency humanitarian waiver today to allow the continuation of PEPFAR-funded HIV treatment across 55 countries, the impact of even this brief interruption has been severe. The waiver permits the resumption of essential medication distribution and medical services. Still, it maintains the broader funding pause for foreign assistance, leaving prevention programs, including condom distribution and PrEP services, suspended.
For people like Azeez Animashaun, a 29-year-old Nigerian activist living with HIV, the consequences could be life-altering. His clinic has closed, preventing him from receiving his scheduled antiretroviral therapy (ARV) on Feb 4.
"I need to take my ARV daily," Animashaun explains. "Poor adherence can cause drug resistance. It will be difficult," he tells OkayAfrica. Having achieved viral suppression—meaning the virus is undetectable in his blood and cannot be transmitted sexually—Animashaun now risks losing this crucial milestone without consistent medication access.
The situation is particularly dire in Nigeria, where PEPFAR provides 76 percent of HIV funding,according to 2021 statistics from the National Agency for the Control of AIDS (NACA). International donors account for 96 percent of all programs for people living with HIV in the country, where approximately1.9 million people live with HIV.
"Line 2 of ARV is hard to access in Nigeria, and Line 3 and Line 4 are even harder," Animashaun says, expressing concern about his ability to find alternative treatment if resistance develops.
ARV treatment is categorized into different lines based on drug resistance and treatment efficacy. First-line medications are the most accessible and widely used in Nigeria, but patients risk developing resistance without consistent treatment, requiring harder-to-obtain alternatives in Lines 2, 3, and 4.
The funding suspension has already halted field testing, economic empowerment programs, and lab services. Key populations affected include gay and bisexual men, transgender women, sex workers, and drug users—communities that already face higher rates of HIV infection and economic instability due to discrimination and marginalization.
HIV advocacy organizations have mainly been silent on the issue. The AIDS Healthcare Foundation in Los Angeles reaffirmed its commitment to patients but declined to provide specific comments to OkayAfrica. Botswana-based Sentebale opted not to give a statement entirely. This silence from major global health organizations raises concerns about the crisis.
"African governments need to come together," Animashaun says. "ECOWAS, the African Union—they can start funding HIV prevention and treatment programs." According to him, the Lagos State AIDS Control Agency (LSACA) is exploring solutions to ensure continued treatment at government hospitals, but specific plans remain unclear.
As Nigeria's already overstretched healthcare system grapples with this sudden loss of PEPFAR support, millions remain vulnerable. The World Health Organization estimates that25.6 million people in Africa are living with HIV, making the continuation of these vital services critical for public health across the continent.
