Impact of Reducing HIV Aid: Nigeria's Human and Global Security Implications

Over twenty years ago, addressing Nigeria's HIV epidemic was a top priority for U.S. President George W. Bush. At that time, Nigeria faced approximately 3.5 million HIV cases, posing a threat not only to regional stability but also to global U.S. interests such as access to the nation's extensive oil reserves, regional security, and lucrative trade partnerships.

In response to growing activism, Bush launched the President's Emergency Plan for AIDS Relief (PEPFAR) in 2003, which has since been instrumental in saving millions of lives worldwide. During my time working as a medical anthropologist in Nigeria, I observed firsthand the transformative impact of PEPFAR. Women living with HIV reported feeling hopeful as they gained access to effective treatment, enabling them to pursue careers, build relationships, and have healthier families.

However, recent policy shifts threaten this progress. The Trump administration's decision to restrict access to PrEP (preexposure prophylaxis), a vital HIV prevention tool funded through PEPFAR, jeopardizes ongoing treatment and future prevention efforts. This restriction comes at a critical time when scientific advancements, such as the development of lenacapavir—an injection providing six months of HIV protection—are revolutionizing prevention strategies.

Undermining access to such treatments risks reversing decades of progress in reducing HIV transmission rates. The consequences extend beyond individual health, affecting global efforts aimed at ending AIDS. The concept of "the afterlife of aid" illustrates how communities are left with lasting distrust and skepticism after aid withdrawal, which can hinder future health interventions.

Cultural realities also complicate HIV management. In Nigeria, women often face the dilemma of balancing health needs with cultural expectations of fertility and marriage, which adds layers of vulnerability and social pressure. Stories like Elizabeth and David’s highlight the personal and cultural intricacies in managing HIV and relationships.

Historically, U.S. aid policies such as the Mexico City Policy have shown how political shifts can cause interruptions in vital health services, leading to increased maternal, child, and HIV-related deaths globally. Nigeria's progress in reducing HIV prevalence—declining from nearly 6% in 2001 to around 1.3% in 2019—has heavily relied on international support, particularly from PEPFAR, which contributed over 80% of the HIV program funding in Nigeria.

The reduction in aid not only risks increasing HIV cases but also endangers broader global security. Public health crises like Ebola and H1N1 have demonstrated how infectious diseases can quickly transcend borders, requiring costly emergency responses. Moreover, U.S. inconsistency in global health funding allows competitors, notably China, to expand influence through bilateral health diplomacy, with China developing extensive health partnerships across Africa.

Restricting access to prevention tools like PrEP forces women into impossible choices—disclosing their status and risking abandonment or violence, or refusing prevention and risking transmission. Such policies threaten to undo the hard-won gains of global HIV programs, undermining the vision of an AIDS-free generation and risking a more vulnerable, less secure world.