MAKURDI, Nigeria – When the flow of U.S. Aid to Nigeria abruptly slowed in early 2025, Josephine Angev feared for her community. As a volunteer “HIV champion” in Benue State, she knew firsthand the lifeline that antiretroviral drugs represented for thousands living with HIV. The aid cuts threatened to unravel years of progress, leaving vulnerable patients without access to the medication they needed to survive. But Angev, along with a network of dedicated volunteers, stepped into the breach, walking dusty paths and knocking on doors to ensure people stayed on treatment – a testament to the power of community in the face of global health challenges.
The crisis underscored Nigeria’s heavy reliance on external funding for its HIV response. For years, the United States had covered approximately 90% of the country’s HIV treatment costs, alongside providing crucial support for healthcare workers. When that support faltered, the consequences were immediate and severe. Clinics faced drug shortages, treatment centers temporarily closed, and patients, often grappling with stigma and misinformation, risked losing access to life-saving care. The situation highlighted a critical vulnerability in global health security and the importance of resilient, locally-driven solutions.
A Community Response to a Looming Crisis
Angev’s work, and that of the Afrocab community support network – a continent-wide non-profit – became a critical buffer against the worst effects of the aid freeze. She and other volunteers didn’t just deliver medication; they provided reassurance, dispelled myths, and navigated the complex social barriers that often prevent people from seeking or continuing HIV treatment. “If we couldn’t reach someone by phone, we went to their house – we traced the address and knocked on their door,” explained Dinah Adaga, who coordinates the volunteers in Benue State. This door-to-door approach proved vital in reconnecting patients to care, particularly those who had stopped treatment due to fear, lack of information, or simply the inability to travel to overwhelmed clinics.
The impact of their efforts was tangible. One 41-year-old mother, who wished to remain anonymous, described her despair upon learning of the aid cuts, fearing she would no longer be able to afford the medication that kept her alive and protected her three HIV-negative daughters. “These drugs mean a lot to me. My future depends on them,” she said, expressing gratitude for the volunteers who helped her resume treatment last November. Stories like hers illustrate the profound human cost of disruptions to HIV care and the critical role of community support in bridging the gaps.
The Disruption of Aid and Nigeria’s Response
The crisis stemmed from a 90-day pause on foreign aid initiated by then-U.S. President Donald Trump in January 2025. Reuters reported at the time that the move prompted widespread concern among aid organizations and recipient countries. In Nigeria, the impact was swift. Treatment centers in Benue State’s capital, Makurdi, were forced to close for a month, and the World Health Organization warned of potential medication stockouts. Patients accustomed to receiving six-month supplies were suddenly limited to just a week or two, creating a logistical nightmare and fueling anxiety.
The Nigerian government responded with a $200 million health funding package within six weeks, which included provisions for HIV treatment. The U.S. Government also issued a waiver for “life-saving” aid, including antiretrovirals, in February 2025. However, the immediate need remained substantial, and the volunteers stepped in to fill the void. Between June and December 2025, they successfully reconnected over 1,000 people in Benue State – including 95 children under five – to HIV care, representing, according to their estimates, nearly everyone who had stopped treatment in the initial months of the crisis.
A Complex Picture: Treatment Access and Prevention Gaps
While the volunteer efforts and government response helped stabilize the treatment landscape, the situation wasn’t without its complexities. UNAIDS Country Director in Nigeria, Krittayawan Boonto, noted that, “We have not received reports of people dying from not accessing antiretrovirals… that’s, for us, a decent sign.” However, she also cautioned that HIV prevention services were disproportionately affected and for a longer duration.
Data from the Civil Society for HIV/AIDS in Nigeria revealed a significant decline in access to HIV prevention tools. The number of people accessing drugs to prevent HIV infection plummeted from 43,000 in November 2024 to below 6,000 in April 2025, and condom distribution fell by 55%. The World Health Organization (WHO) has warned that gaps in prevention efforts will inevitably lead to an increase in new infections. Testing rates also declined, with over a million fewer people tested for HIV in 2025 compared to the previous year, raising concerns about undiagnosed cases.
A New Agreement and a Path Forward
In December 2025, the U.S. And Nigeria signed a new health agreement for 2026-2030, committing $2.1 billion from the U.S. And $3 billion from Nigeria to strengthen the country’s health systems. The agreement prioritizes the HIV response and aims to put more patients on treatment programs, with a long-term goal of Nigeria assuming full financial responsibility for its HIV program over the next five years. However, the agreement also stipulates that U.S. Funding will be directed towards workers “formally recognised within government structures” and places “a strong emphasis on Christian faith-based healthcare providers,” reflecting a broader U.S. Strategy to support Nigeria’s Christian population.
Despite the challenges, the resilience demonstrated by volunteers like Josephine Angev offers a glimmer of hope. “It can be exhausting, but we do it so lives that might have been lost are instead restored,” she said. “And when you see them living better lives and truly changed, that’s when you feel happy.”
Looking ahead, the success of Nigeria’s HIV response will depend on sustained funding, strengthened local capacity, and a continued commitment to reaching those most vulnerable. The next key milestone will be the full implementation of the new U.S.-Nigeria health agreement and the monitoring of its impact on treatment and prevention outcomes.
If you or someone you realize is living with HIV, resources are available. You can find information and support from UNAIDS (https://www.unaids.org/) and the World Health Organization (https://www.who.int/health-topics/hiv-aids).
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