Sheriff Gbadamosi and Aaron Bawala (Lead writers)
For over two decades, Nigeria’s HIV response has been heavily funded by external donors like the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund. These resources helped scale testing, treatment, and awareness campaigns across communities, especially among key populations and vulnerable groups. But today, funding cuts and shifting global priorities have strained these gains, with ripple effects becoming increasingly visible.
PEPFAR, which has contributed almost $8 billion to Nigeria’s HIV response since 2004, is under pressure. As part of its long-term sustainability strategy, funding is shifting towards countries demonstrating local ownership. Meanwhile, the Global Fund’s new allocation model requires co-financing, something many subnational actors in Nigeria are struggling to meet.
As a result, community HIV testing initiatives, particularly in rural areas, are experiencing reduced frequency, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS), Some community-based service delivery points are facing significant service interruptions, and there are currently no plans for referrals to other facilities. However, the Nigerian government has responded to the suspension of US-funded programs and approved N4.8 billion for procuring 150,000 HIV treatment packs under the 2024/2025 HIV Programme Alignment. The government is also strengthening national systems, securing local financing, and engaging the private sector, including plans to establish an AIDS Trust Fund.
In addition, the National Agency for Food and Drug Administration and Control (NAFDAC) has approved the use of self-testing kits since 2019, with over 3,000,000 kits distributed in Nigeria. However, how can individuals prioritise self-care through testing when the infrastructure that supports them is weakening?
While the policy discourse often centres around numbers and targets, on the ground, communities are grappling with a different reality: how to keep HIV testing alive without the lifeline of external funding.
Amid the uncertainty, remarkable stories of resilience are emerging.
Community responses filling the gaps
In the heart of Benue State, which has a high HIV prevalence compared to the national average, community-driven initiatives are essential. Programmes like community-based antiretroviral therapy (CBART) and the use of low-cost HIV self-testing (HIVST) kits, as recommended by the World Health Organisation (WHO), play a crucial role in reaching and engaging individuals at risk. These efforts rely on intermittent outreach funding and a coalition of local NGOs, healthcare workers, and people living with HIV (PLWHIV). Utilising low-cost HIVST kits and peer educators from within the community is helping to reach households that have long been disconnected from the formal health system.
In 2019–2021, the AIDS Prevention Initiative in Nigeria (APIN) programme implemented the Benue ART surge (BAS) to close the ART coverage gap of 11% out of the combined gap of 320,921 in the country. The implementation was initiated in 252 health facilities, and out of 893,462 clients reached, 60,297 were diagnosed with HIV and 60,236 were initiated on ART.
The key lesson from this intervention was the collaborative approach initiated to bring together the State Government, PEPFAR, community-based organisations (CBOs), and the private sector to achieve the targets, take ownership, and sustain the HIV programmes in the State.
Similar innovations are emerging across the country. In Lagos State, a community-driven approach to testing and counselling services has been adopted, especially in the hard-to-reach settlements in collaboration with the Ministry of Agriculture. This approach helps reduce stigma and expand access supporting progress towards the UNAIDS 95–95–95 targets.
In Kano State, the government has revamped the free HIV centres in over 600 health facilities in the state including private hospitals and signed into law the Pre-Marital Screening Law & Anti-Discrimination Law. These examples prove a vital point: where funding fades, community ingenuity often steps in, empowering young people on HIV literacy and testing. But even the most resilient local responses are not silver bullets; they cannot replace the scale, coordination, and infrastructure that national HIV programmes depend on.
According to Dr Tony Ojukwu, the Executive Secretary of the National Human Rights Commission (NHRC), “in Nigeria, we have well-meaning individuals who are capable of covering some of these costs. It is not mandatory that all funding must come from America or other Western countries.” But how do we bring in this philanthropist and private organisation to be aware of these problems and get their commitment to fund these interventions?
The fragility of innovation without support & long-term sustainability plan
While community-led HIV responses show great promise, they face significant challenges. Many operate at a small scale and depend on short-term donor funding or volunteer support, which threatens their long-term sustainability. In addition, gaps in infrastructure for confirmatory testing, treatment linkage, and drug resistance monitoring limit effectiveness.
For instance, under the Nigeria HIV/AIDS Programme Development Project I and II, 564 CSOs reached over 2.4 million people across 33 states, including 161,000 most-at-risk individuals. Yet, despite this impact, the achievements were not sustained due to funding gaps, underscoring how community resilience alone cannot uphold long-term HIV response goals without stable investment.
Relying on communities to fill funding gaps is unsustainable. Their efforts should support, not replace national HIV strategies. Ongoing funding cuts risk progress and place an unfair burden communities already stretched thin.
A call to protect the promise
Resilience alone cannot secure an AIDS-free future. Policymakers must confront the cost of funding cuts, not just in lives lost, but in broken trust and weakened systems.
Communities are stepping up, but they cannot do it alone. People living with HIV must stay informed, use their voices to demand equitable care, and harness social media to push for sustained funding and engage with the private sector for alternative funding for HIV testing and treatment.
Everyone must have the tools to check their status with dignity and the power to shape the future of HIV testing and care in Nigeria.