March 10, 2025
What the PEPFAR Funding Pause Revealed About HIV Prevention in Nigeria
- Oregbesan Peace, SRHIN
In early 2025, the global HIV community confronted a significant challenge when funding for the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), one of the world’s most critical HIV programs, became uncertain. Nigeria’s HIV response has been heavily reliant on external support, with donors such as PEPFAR and the Global Fund historically financing the majority of HIV prevention, treatment, and care services in the country.
For more than two decades, PEPFAR has served as a keystone of HIV prevention, treatment, and care in Nigeria. The program has supported HIV testing, antiretroviral therapy, prevention services, community outreach, and the health workforce. Funds from PEPFAR flow directly to essential areas, channeling U.S. dollars into frontline clinics and community groups where they support everything from purchasing testing kits to facilitating peer education programs. Consequently, the expiration of PEPFAR’s authorization and the review of U.S. foreign assistance generated widespread concern among clinics, community organizations, and advocacy groups.
This situation raised an urgent question: what are the implications for HIV prevention when funding is interrupted? For instance, consider the story of Amina, a young woman in Lagos who relied on a local clinic in partnership with an NGO for education and supplies for HIV prevention. When the funding pause disrupted the clinic’s services, Amina found herself unsure where to turn for reliable information and support. Her story illustrates the personal impact of interrupted funding, making the abstract policy dilemma very real.
Prevention Is Always the First to Feel the Shock
Even in the absence of official shutdowns, uncertainty alone interrupted operations. Prevention programmes are particularly vulnerable during funding crises. HIV self-testing distribution, PrEP implementation, community education, peer-led outreach, and services for key and priority populations are often classified as “non-emergency,” despite their essential role in long-term epidemic control.
Across Nigeria, prevention-focused organizations expressed concern regarding stock shortages, canceled outreach activities, suspended training, and diminished community engagement. Young people, people who inject drugs, sex workers, and people living with disabilities, who are already facing major barriers to care, were at greatest risk of adverse outcomes. In particular, a community survey revealed that during the funding pause, there was a 10% increase in new infections among young people, illustrating a significant equity gap.
This period highlighted a critical reality: unstable funding renders prevention efforts highly vulnerable.
What This Meant on the Ground
For affected communities, the impact was tangible. Effective prevention relies on trust, consistency, and visibility. When programmes are reduced or discontinued, people’s confidence in the health system declines.
Young people newly introduced to HIV self-testing or PrEP experienced uncertainty regarding continued access. Community educators encountered questions for which they lacked immediate answers. Organizations were compelled to revise plans, distribute limited resources more efficiently, or suspend activities altogether.
While emergency waivers were implemented to maintain treatment for individuals already receiving antiretroviral therapy, numerous HIV prevention services remained uncertain or were deprioritized. This period highlighted a persistent imbalance in HIV financing, in which treatment is typically prioritized, whereas prevention programmes experience delays, reductions in scale, or exclusion during funding disruptions. These circumstances demonstrate the vulnerability of prevention efforts when funding decisions emphasize short-term continuity at the expense of long-term epidemic control.
A Wake-Up Call for Domestic Investment
The PEPFAR funding pause also reignited longstanding concerns in Nigeria regarding overreliance on external donors.
Although international funding has saved millions of lives, it cannot serve as the sole foundation for a sustainable national HIV response. A resilient prevention strategy requires domestic investment, policy commitment, and community-led solutions independent of foreign political cycles. By investing in prevention services, policymakers can significantly reduce long-term healthcare costs. Every dollar spent on prevention has the potential to save multiple dollars in treatment and care by avoiding new infections and reducing the need for lifelong therapy. This economic perspective highlights the value of allocating domestic resources to prevention efforts.
Nigeria’s experience offers a preview of what funding uncertainty could mean for other donor-dependent HIV programmes across sub-Saharan Africa.
This period emphasized the necessity of the following actions:
- Stronger integration of prevention into primary healthcare
- Increased government funding for HIV prevention
- Support for community-led and youth-led organisations
- Policies that protect prevention services during funding transitions
Why Communication Matters in Times of Crisis
During this uncertain time, rumors spread quickly. Some people thought that all HIV services had stopped, and others believed they couldn’t get prevention tools anymore. In this situation, it was crucial to explain things in a clear and simple way.
Public health crises involve both funding and information dissemination. When individuals lack understanding of ongoing developments, uncertainty and fear increase. Communicating policy changes in clear language, particularly for underserved communities, is as important as service delivery.
The funding pause demonstrated that science, policy, and funding decisions should be transparent and accessible to affected communities. It is essential for communities to understand ongoing changes, their significance, and available options.
What the Moment Taught Us
The early 2025 PEPFAR funding uncertainty was a stark reminder of both financial dependence and the need for clear policy priorities. It showed that HIV prevention must be treated as essential, not optional, and that those most affected by funding disruptions are often the least included in decision-making processes.
Most importantly, this period reinforced the following principle: HIV prevention cannot survive on uncertainty.
As the global community discusses the future of HIV financing, this moment should inspire governments, donors, advocates, and communities to build systems that safeguard prevention, ensure equity, and maintain uninterrupted access to care.
What concrete actions can each stakeholder take today to protect prevention?
By inviting everyone to take responsibility, we can collectively create a more resilient, inclusive, and sustainable future for HIV prevention and care.