Funding Cuts Expose Deep Cracks In HIV Care Across Rivers & Akwa Ibom

By JULIET EKANEM

An HIV Programme at a Turning Point

NIGERIA’S HIV response has entered one of its most challenging periods in recent years.

While treatment services remain available in many facilities, growing evidence from Rivers and Akwa Ibom suggests that the withdrawal of several donor-funded community programmes has significantly weakened patient support systems.

Healthcare professionals, advocacy organisations and people living with HIV say the consequences are becoming increasingly visible.

They point to disrupted community outreach, reduced home-based services, shrinking peer support networks and overstretched health facilities.

Together, these developments raise important questions about the country’s readiness to sustain HIV programmes through domestic resources.

Beyond Medication

Managing HIV extends beyond prescribing antiretroviral drugs.

Successful treatment depends on consistent counselling, laboratory monitoring, appointment reminders, adherence support, psychosocial care and community engagement.

For years, these services were funded largely by international partners.

Community workers visited patients unable to reach hospitals.

Peer counsellors helped newly diagnosed individuals cope with stigma.

Support groups encouraged treatment adherence and mental wellbeing.

Many of those programmes have now been reduced following international funding changes.

Health workers say their disappearance has left significant gaps in patient care.

Patients Face New Barriers

Interviews conducted with affected individuals reveal recurring concerns.

Some patients now travel longer distances to collect medicines.

Others struggle with transportation costs.

Several report spending hours waiting in overcrowded clinics.

Patients who previously relied on confidential community delivery fear unwanted disclosure of their HIV status.

Advocates say stigma continues to discourage some individuals from attending treatment facilities despite years of awareness campaigns.

They argue that rebuilding trust requires restoring community-based services that once protected patient privacy.

The Human Resource Gap

Healthcare officials say one of the biggest losses has been trained personnel.

Donor-funded programmes supported counsellors, data officers, laboratory assistants, community trackers and peer educators.

Many of these workers were not absorbed into government payrolls after funding reductions.

Their departure has increased pressure on existing health workers.

Clinics now face heavier workloads with fewer staff.

Public health specialists warn that staff shortages can affect treatment quality, patient retention and disease surveillance.

Funding Dependency Under Scrutiny

Financial records illustrate the scale of Nigeria’s dependence on external HIV financing.

According to NACA’s National AIDS Spending Assessment, international partners financed nearly all HIV programme expenditures in recent years.

PEPFAR and the Global Fund have remained the principal financiers of treatment, testing, laboratory services and community interventions.

Analysts note that while donor investments saved millions of lives, they also delayed the development of stronger domestic financing mechanisms.

As external priorities change, Nigeria increasingly faces the responsibility of sustaining these programmes independently.

Transition Without Adequate Preparation

The Federal Government has introduced policies designed to improve domestic ownership of HIV programmes.

NACA’s sustainability framework envisions greater financial contributions from federal and state governments alongside improved institutional capacity.

Health policy experts acknowledge the importance of the strategy.

However, they argue that implementation has not matched the urgency created by declining donor support.

Several advocacy organisations report that appeals for stronger government intervention received limited attention until services had already begun contracting.

The result, they say, is a transition that many patients perceive as abrupt and incomplete.

Protecting Decades of Progress

Nigeria has invested decades in reducing HIV-related deaths and expanding treatment coverage.

Those achievements remain significant.

However, maintaining them will require more than continued drug procurement.

Experts recommend increased domestic healthcare financing, recruitment of additional health workers, stronger community partnerships, expanded psychosocial support and improved monitoring of patients at risk of dropping out of treatment.

They also stress the importance of integrating HIV services into broader primary healthcare reforms.

The Road Ahead

The experiences documented in Rivers and Akwa Ibom illustrate the broader challenges confronting Nigeria’s public health system as international funding patterns evolve.

The central question is no longer whether donor support will decline.

It is whether governments at every level can successfully replace the systems that donors helped build.

Health experts believe the answer will determine not only the future of HIV care but also Nigeria’s ability to achieve national and global targets for ending AIDS as a public health threat.

The choices made over the coming years, they argue, will shape whether recent setbacks become temporary disruptions or the beginning of a reversal in one of Nigeria’s most important public health achievements.