By Mary Agidi

|

“My wife and I have been an HIV-positive couple for about 36 years now, but we are healthy, and our children are not infected. We’ve been receiving free medications all these years and have been taking our drugs appropriately. The accessibility of free medications is due to the intervention of foreign donor agencies. If they stop, many will die.”

These were the words of Prince Aladelusi Adesina, the Ondo State Coordinator of the Network of People Living with HIV (NEPWHAN), as part of his message for World AIDS Day 2024, observed on December 1.

On this World AIDS Day, governments, civil society organizations, faith-based organizations, and individuals participated in a solidarity campaign to honour those living with HIV and those who have died from AIDS-related conditions.

In Nigeria, People Living With HIV (PLWHIV) have enjoyed free antiretroviral drugs for years, thanks to generous donations from foreign organizations like the Global Fund, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), and UNAIDS. Recently, however, these foreign donors have indicated the possibility of withdrawing their support in a few years, as their funding has begun to dwindle.

In October 2024, these donors clarified that they do not intend a total withdrawal but rather a shift to a new model. They announced that the Nigerian government must now take full responsibility for sustaining HIV response efforts through a New Business Model (NBM). This model, set to take effect in 2026, involves transitioning from NGO-led HIV response programmes to a government-led implementation approach. Under this system, any subsequent donor funding will go directly to the government instead of non-governmental implementing partners, who have previously managed the programmes.

The aim is to prepare the Nigerian government for the eventual cessation of donor funds and ensure the sustainability of HIV response efforts.

However, this new model has sparked concerns among beneficiaries of donor support, particularly NEPWHAN. As expressed by the Ondo State Coordinator, fears center on the government’s efficiency, effectiveness, and sincerity in managing HIV response programmes.

The donor’s intervention provided the distribution of drugs, monitoring of patients to ensure proper drug usage, provision of pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) to key populations to prevent new infections, and capacity-building programmes for stakeholders involved in HIV advocacy.

The Ondo NEPWHAN Coordinator revealed that despite the interventions and investments made by donors, some PLWHIV do not take their drugs as prescribed, if not for monitoring and supervision. He warned that if free access to care diminishes due to donor withdrawal, “many deaths” will occur.

He also lamented the rising number of infections in the state, attributing this to low sensitization and reduced efforts by the government agency responsible for HIV/AIDS prevention.

Furthermore, the decline in media advocacy on HIV infections, compared to about a decade ago when the media space was flooded with information on HIV response efforts, has led to reduced awareness. As a result, it appears as though HIV has been defeated, which is far from reality.

In 2023 alone, an estimated 39.9 million people were living with HIV globally, approximately 630,000 people died from HIV-related causes, and an estimated 1.3 million people newly acquired HIV, according to the World Health Organization’s (WHO) 2024 World AIDS Day message.

In its World AIDS Day message, PEPFAR announced its collaboration with implementing partners across 55 countries, including Nigeria, to sustain progress and accelerate efforts to end HIV/AIDS as a public health threat by 2030.

Since 2003, PEPFAR has been steadfast in supporting lifesaving treatment for people living with HIV, saving 26 million lives and enabling 7.8 million babies to be born HIV-free.

It, however, emphasized the importance of transitioning to government-led and community-driven HIV response programmes to ensure sustainability beyond 2030.

In its latest Global Results and Projections Factsheet released in December 2024, PEPFAR revealed significant achievements: 20.6 million people are on life-saving antiretroviral treatment, 2.5 million people were newly enrolled in PrEP to prevent infections; 2.3 million adolescent girls and young women received comprehensive HIV prevention services; 83.8 million people accessed HIV testing services; 6.6 million orphans, vulnerable children, and caregivers received critical care, while 342,000 health workers were directly supported by PEPFAR.

Additionally, 95% of adults and 89% of children are currently virally suppressed through PEPFAR’s intervention.

UNAIDS estimates also show that new HIV infections in 2023 were 52% lower in PEPFAR-supported countries than in 2010, compared to a 39% reduction globally. AIDS-related deaths also declined by 59% in PEPFAR-supported countries, compared to 51% globally.

PEPFAR accounts for more than 90% of pre-exposure prophylaxis (PrEP) initiations for HIV prevention worldwide. In 2024, the programme provided HIV testing services to 83.8 million people, 12 million more than in 2023. Since 2007, PEPFAR has facilitated 35.1 million voluntary medical male circumcisions for HIV prevention, including 2.7 million in 2024.

In light of the planned shift to local leadership in HIV prevention, treatment, and care Programmes, Dr. Funmi Adesanya, PEPFAR Coordinator in Nigeria, emphasized that HIV is no longer considered an emergency but remains a persistent infectious disease crisis. Speaking to Nigerian journalists virtually on World AIDS Day, she reaffirmed PEPFAR’s commitment to achieving the global 95-95-95 targets to end HIV as a public health threat by 2030, despite declining financial resources.

She urged civil society organizations in Nigeria to actively participate in shaping the future of HIV programmes and to hold the government accountable for sustaining efforts. She emphasized the importance of collaboration and community involvement in achieving sustainability.

Dr. Matshidiso Moeti, WHO Regional Director for Africa, reiterated the link between HIV and social factors like poverty and gender inequality, emphasizing that protecting human rights is essential for achieving universal HIV care.

Similarly, the Global Fund highlighted the growing HIV funding gap in its 2024 World AIDS Day message, stressing the need for innovative finance mechanisms that leverage government spending and domestic health financing.

With the transition to government-led implementation, civil society organizations must collaborate with the government to ensure accountability and effective resource allocation, says Mr. Ibrahim Tajudeen, Executive Secretary of the Country Coordinating Mechanism for Global Health in Nigeria.

Dr. Leo Zekeng, Country Director of UNAIDS, also stressed the importance of maintaining current progress, warning that reduced efforts could lead to increased new infections and fatalities in Nigeria.