Nigeria Faces Rising HIV Cases After U.S. Cuts Preventative Aid for Key Populations

 Emmanuel Cherem, a 25-year-old gay man in Awka, has tested positive for HIV just two months after former U.S. President Donald Trump’s administration cut off access to Pre-Exposure Prophylaxis (PrEP). The medication—a daily tablet that reduces the risk of contracting HIV during sex by up to 99%—was withdrawn from at-risk communities, including gay men and people who inject drugs.

Speaking from his gym, Cherem acknowledged his own responsibility while also pointing to the policy change:
“I blame myself… Taking care of myself is my first duty as a person,” he said. “I equally blame the Trump administration because, you know, these things were available, and then, without prior notice, these things were cut off.”

In January, President Trump imposed a 90-day suspension on foreign aid, halting grants by USAID that funded the bulk of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)—the world’s largest HIV/AIDS initiative. The interruption had profound effects, particularly in sub-Saharan Africa, limiting access to life-saving prevention tools such as PrEP, condoms, and lubricants.

PrEP usage in Africa skyrocketed from under 700 initiations in 2016 to more than 6 million by late 2024—over 90% of which were funded through PEPFAR and generic formulations. Yet, as of 2023, sub-Saharan Africa still accounted for 62% of the world’s 390,000 AIDS-related deaths. While deaths have dropped 56% since 2010, health experts warn that the recent funding gap may reverse that progress.

“I just see this as incredibly short-sighted because we were on a winning path,” said Linda-Gail Bekker, an HIV specialist at the University of Cape Town, adding that many African governments lack the resources to replace PrEP funding.

UNAIDS has warned that ceasing PEPFAR-supported prevention programs could result in an additional 2,300 new HIV cases globally per day, on top of the 3,500 new cases reported daily in 2023. Multiple public health workers, PrEP users, and activists quoted by Reuters say that the rise in infections is unquantifiable due to the collapse of many community programmes.

A U.S. State Department waiver issued in February allowed some PEPFAR activities to resume—primarily those preventing mother-to-child HIV transmission—but exclusion of PrEP for gay and bisexual men, sex workers, and injecting drug users remains. These groups had been specifically targeted by national PrEP rollouts in several countries.

In East and Southern Africa, where more than half of the world’s HIV-positive population lives, the U.S. had funded approximately 45% of HIV prevention efforts, according to UNAIDS. Some countries—such as Malawi, Zimbabwe, and Mozambique—were almost entirely dependent on PEPFAR; in others, like South Africa and Kenya, it contributed less than 25%.

At Nigeria’s HER Initiative in Awka, executive director Festus Alex Chinaza confirmed that several gay and bisexual men who previously took PrEP have recently tested HIV-positive. One, identified as Echezona, a 30-year-old, stopped PrEP use in early May and subsequently received a positive diagnosis.

“I just pray and wish that Trump actually changes his policy and everything comes back to normal so that the spread and transmission of the virus would be reduced,” he told Reuters, asking to withhold his surname due to stigma.

Nigeria has an adult HIV prevalence of 1.3%, with approximately 2 million people living with the virus—making it the fourth-largest national population globally. Among gay men, prevalence remains as high as 25%.

In South Africa—home to an estimated 7.7 million people living with HIV—public funds finance most PrEP, but some clinics serving key populations depended on PEPFAR and have since closed. Activists note that many LGBT individuals avoid public health facilities due to harassment or stigma.

Francois Venter, director of Ezintsha at the University of the Witwatersrand, noted that PrEP distribution in Johannesburg city-centre public clinics has stagnated since the American funding cuts. South Africa’s health ministry, however, asserts that officials are working to ensure safe access for all healthcare seekers. Spokesperson Foster Mohale stated that staff have been “sensitised to create a conducive environment for all healthcare seekers/clients to access the service without feeling judged or discriminated against.”

As global funding uncertainty continues, public health experts say that without renewed support, recent gains in HIV prevention could unravel, particularly among marginalized communities.