HIV Funding Gap: How Government Inaction Threatens Patients In Rivers, Akwa Ibom
By JULIET EKANEM
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When Community Support Disappears
GRACE* never studied a government budget or examined how Nigeria finances its HIV response. She only knew that a community health worker once delivered her antiretroviral medicines discreetly, offered counselling and helped her remain in treatment without exposing her status.
Then the service stopped.
Grace had to collect her medication from a public treatment centre. Someone recognised her there. The experience exposed her to the stigma she had tried to avoid, and she eventually stopped attending treatment.
Her experience illustrates a wider problem facing Nigeria’s HIV response as international donors reduce support for community-based programmes.
An investigation based on budget documents, implementation reports, government expenditure records and interviews with officials, programme managers, health advocates and people living with HIV found significant gaps between government promises and actual spending in Rivers and Akwa Ibom, two of Nigeria’s high-burden states.
Governments have continued to approve HIV allocations. However, available records show that large portions of those allocations did not reach the agencies responsible for implementing the programmes.
Budgets Approved, Money Not Released
In Akwa Ibom, the State Agency for the Control of AIDS received capital allocations in successive budgets.
The state earmarked ₦24.05 million in 2023, ₦10 million in 2024, ₦33 million in 2025 and ₦150 million in the 2026 budget.
The allocations covered activities such as HIV testing, antiretroviral medicines, condoms and screening materials.
Yet budget implementation reports reviewed for 2023 and 2024 showed no capital releases to the agency.
The state has also not published the 2025 capital implementation report or the first-half 2026 report, limiting public scrutiny of subsequent spending.
Commissioner for Health Ekem Emmanuel said the agency received some government support towards the end of 2025. However, neither his office nor the state AIDS agency provided documentary evidence showing the amount released, its source or the programmes it funded.
NACA’s assessment provided another indication of the gap. The agency reported that Akwa Ibom released only one per cent of its total HIV appropriations for 2024 and 2025.
If that figure represents the ₦33 million 2025 allocation cited in the investigation, the actual spending would amount to roughly ₦330,000.
Rivers Shows a Similar Pattern
Rivers State presents a comparable picture.
The state appropriated ₦180 million for HIV interventions in 2023 and ₦230.66 million in 2024.
Those allocations covered HIV testing materials, community counselling, condom distribution and the proposed development of an anti-stigma law.
However, corresponding implementation reports showed no releases against those appropriations.
Rivers has not published the fiscal documents required to independently examine its 2025 and 2026 HIV expenditure. Repeated requests for clarification from officials of the State Agency for the Control of AIDS also produced no explanation about whether funds were subsequently released.
NACA reported zero HIV/AIDS releases by Rivers during the period under review.
The Human Cost of Unreleased Funds
The figures may appear like accounting discrepancies, but their consequences reach directly into communities.
An unreleased allocation can mean that health workers cannot trace patients who miss appointments. It can mean fewer community testing programmes, reduced prevention campaigns and weaker support for people dealing with HIV-related stigma.
Uduak Nyaetok, Executive Director of Milestone Initiative for Human Rights and Empowerment, said HIV treatment depends on much more than the availability of antiretroviral drugs.
According to her, effective treatment begins with testing and diagnosis and continues through counselling, follow-up, adherence support and community engagement.
She said donor-funded community programmes previously provided much of that support.
When those programmes were interrupted, she argued, patients who depended on community workers lost an important link to treatment.
NACA acknowledged that US-funded structures experienced setbacks in community-level case finding, pre-exposure prophylaxis uptake and condom distribution.
Federal Spending Raises More Questions
The funding problem extends beyond state governments.
Federal spending records reviewed between 2021 and 2026 also show a gap between budget approvals and actual expenditure.
In 2025, the Federal Government approved ₦18.27 billion in capital expenditure for NACA, more than twice the previous year’s allocation.
However, Govspend records showed that only 31.2 per cent of the allocation had received cash backing.
The situation deteriorated in 2026. The government budgeted ₦13.97 billion for NACA, but spending records showed only ₦36.68 million had been spent between January and May.
NACA later said its releases improved by June, when it had received 3.8 per cent of the approved allocation.
More troublingly, only ₦16.13 million of the January-May expenditure went directly to an HIV response programme, according to the records reviewed. Other spending included cleaning services and staff welfare.
One transaction involved ₦7.4 million for cleaning services, while another involved ₦13.12 million for the supply of rice and vegetable oil for NACA staff.
These expenditures raise questions about how effectively Nigeria is deploying scarce domestic resources while donors reduce direct support.
A Wider Sustainability Problem
NACA maintains that the Federal Government is pursuing measures to strengthen domestic HIV financing.
The agency pointed to the HIV Trust Fund of Nigeria, the integration of HIV services into state health insurance schemes and the use of mechanisms such as the Basic Health Care Provision Fund.
It also said the Federal Government injected $200 million into the 2025 federal budget to address health financing gaps.
However, the investigation found that NACA spent only ₦5.7 billion from the reported allocation.
The contradiction between funding commitments and actual expenditure therefore remains difficult to ignore.
Smaller Epidemics, Stronger Spending
The contrast becomes clearer when Rivers and Akwa Ibom are compared with states carrying smaller HIV burdens.
Kwara, for example, had an estimated 20,259 people living with HIV but spent ₦608.63 million on HIV interventions in 2024, according to a reviewed implementation report.
The state also released ₦132.16 million in counterpart funding for Global Fund-supported HIV and malaria programmes between January and September 2025.
Its 2026 budget earmarked ₦8.29 billion for Global Fund-supported health interventions, including HIV.
Zamfara, despite having an estimated 13,253 people living with HIV, recorded ₦3.42 million in direct HIV spending in 2025. Yobe, which has the lowest estimated HIV burden, recorded ₦500,000.
These figures do not mean that the lower-burden states have solved their financing problems. They demonstrate, however, that governments can translate HIV budget commitments into actual spending.
The Deadline Is Getting Closer
Nigeria faces a shrinking window to protect the gains made against HIV.
The global 95-95-95 targets require 95 per cent of people living with HIV to know their status, 95 per cent of those diagnosed to receive sustained treatment and 95 per cent of those receiving treatment to achieve viral suppression.
Those targets require sustained investment in testing, counselling, patient follow-up, laboratory services and community support.
NACA said Nigeria remains positioned to achieve the 2030 targets but acknowledged that funding instability from governments and donor partners poses a significant risk.
For people like Grace, however, the consequences are immediate.
A budget allocation means little to a patient when the community worker disappears, the counselling ends and the pathway to confidential treatment breaks down.
(Names marked with an asterisk have been changed to protect vulnerable individuals featured in the investigation.)
