Cutting HIV aid, Nigeria shows the human costs

NEW DELHI: A little over two decades ago, addressing Nigeria’s HIV crisis topped US President George W. Bush’s priorities. Africa’s most populous nation had 3.5 million HIV cases, and the disease threatened to destabilise the region and ultimately compromise US interests. These interests included securing access to Nigeria’s substantial oil reserves, maintaining regional military stability and protecting trade partnerships worth billions.

Following years of agitation from AIDS activists, Bush launched the President’s Emergency Plan for AIDS Relief, or PEPFAR, in 2003. This US-led HIV treatment programme has since saved tens of millions of lives around the globe.

While living in Nigeria for my work as a medical anthropologist, I witnessed PEPFAR’s rollout and saw firsthand how the powerful therapies it provided transformed Nigerian lives. The women I worked with told me they could finally put aside the fears of death or abandonment that had consumed their days. Instead, they could focus on a newly expanded horizon of possibilities: building careers, finding love, and having healthy children.

Now, however, a serious threat to preventing and treating HIV worldwide looms. The Trump administration’s decision to substantially restrict access to a vital HIV prevention tool – PEPFAR-funded preexposure prophylaxis, or PrEP – would cut off ongoing treatment for millions of people and block future access for countless others who need this protection.

The timing is devastating: Scientists recently made a major advance in HIV prevention. Named the 2024 Breakthrough of the Year by the journal Science, the drug lenacapavir offers six months of HIV protection with one injection. Unlike previous PrEP options that required daily pills, which created significant barriers to consistent access and adherence, this twice-yearly injection dramatically simplifies prevention.

By undermining access to a treatment that has been essential to reducing HIV rates, the Trump administration’s new restrictions threaten to derail two decades of bipartisan investment in eliminating HIV globally. The consequences extend well beyond individual lives.

My research in Nigeria also reveals the fragile progress that now hangs in the balance. Before treatments arrived, HIV ravaged Nigerian communities. In 2001, nearly 6% of the population had HIV, totalling around 3.5 million people.

The Hausa language reflected this trauma: Terms for AIDS also meant “lifeless body” and “nearby grave.”

Following the rollout of HIV treatments, Nigeria’s cases dropped dramatically – by 2010, prevalence had fallen to 4.1%.

In 2019, around 1.3% of the population had HIV, or 1.9 million people.

Public health crises rarely stay contained within national boundaries. When health systems fail in West Africa, diseases can quickly spread overseas and require costly emergency responses. The 2014 Ebola outbreak demonstrated this reality, when cases reached America and prompted a $5.4 billion emergency response.

Similarly, the 2009 H1N1 influenza pandemic, which infected around 60 million Americans, showed how quickly infectious diseases circle the globe when surveillance and containment systems are inadequate.

Inconsistent aid, in turn, undermines American global leadership and creates openings for competing powers to establish their influence. China has actively exploited these gaps, establishing bilateral trade with Africa, reaching $295 billion in 2024. While the US reduced its global health engagement during previous administrations, China expanded its global health diplomacy.

Meanwhile, restrictions in PrEP access risk recreating the same impossible choices women faced at the advent of the epidemic: choosing between disclosing their status and risking abandonment; accepting unprotected sex and risking transmission, or refusing unprotected sex and risking violence or loss of economic support.

I believe the result is a far less safe world where preventable suffering continues, hard-won progress unravels and the promise of an AIDS-free generation remains unfulfilled.