“Without access to ARVs, we will see an increase in HIV-related deaths. The situation is dire.” – Dr. Abdullahi Balog
President Donald Trump’s foreign aid freeze is causing panic across African countries, leaving millions of lives in jeopardy. In South Africa, where the world’s largest HIV epidemic continues to claim lives, the abrupt shutdown of PEPFAR-funded clinics has left thousands without medical support.
A USAID-funded sexual health clinic in Johannesburg has already been closed. According to an MSN report, a woman was seen on Thursday standing outside the clinic, waiting for it to open. Finding no one to assist her, she looked visibly disturbed, her voice trembling with distress. Now, she is left scrambling to find another facility for Pre-Exposure Prophylaxis (PrEP) and routine HIV screenings. For many sex workers, these clinics were their only access to safe and reliable healthcare.
A HIV-positive patient from the same closed clinic shared her patient transfer letter, revealing that she has yet to be registered at another facility. South Africa, home to 8.5 million HIV-positive individuals—a quarter of the world’s HIV cases—relied heavily on U.S. aid for treatment. Now, thousands are at risk of losing access to lifesaving medication.
“In the early 2000s, we had no medication. The government told us to take beetroot and garlic,” recalls Nelly Zulu, an activist and mother living with HIV in Soweto. “We fought hard to win this battle, and now, we are being pushed back into that struggle.”
Zulu, who has been on lifesaving ARV treatment for more than two decades, fears for the most vulnerable: pregnant women and children. “I don’t want them to go through what I went through. If PEPFAR disappears, millions will suffer.”
Civil society organizations across South Africa have issued a joint open letter to the government, urging an immediate response to the healthcare crisis triggered by Trump’s foreign aid freeze. The letter warns that nearly one million HIV patients have been directly affected by the stop-work orders stemming from the funding suspension.
Ethiopia Faces Severe Healthcare Disruptions
In Ethiopia, many healthcare centres have closed, and nearly 5,000 public health workers, whose contracts were funded by the U.S., have lost their jobs. Community clinics, which are entirely dependent on U.S. government funding, are facing the biggest disruptions.
Despite a waiver allowing limited healthcare assistance, the situation remains chaotic. Experts warn that without PEPFAR reauthorization between 2025 and 2029, AIDS-related deaths could rise by 400%, leading to nearly 6.3 million deaths in the coming years.
Nigeria Faces Uncertain Future as PEPFAR Suspension Hits Hard
Nigeria, which has the highest HIV burden in West and Central Africa, is also struggling with the effects of the PEPFAR freeze. With nearly two million Nigerians living with HIV and 1.7 million children orphaned by AIDS, the country has relied heavily on U.S. funding, which has contributed over $6 billion to HIV/AIDS programs.
The funding suspension has alarmed Nigerian health officials, who fear a looming public health disaster. “This suspension is devastating. It will put millions of lives at risk,” warns Dr. Abdullahi Balogun, a medical doctor at Obafemi Awolowo University Teaching Hospital (OAUTH).
“Without access to ARVs, we will see an increase in HIV-related deaths. The situation is dire.”
Doctors warn that hospitals may be forced to introduce user fees, making lifesaving treatment unaffordable for many patients.
In Lagos, 42-year-old Stephen Enoch, an HIV-positive patient, shared his deep concern: “I don’t want to die. I rely on these drugs to stay alive. Without them, what happens to me?”
Another patient, speaking anonymously due to stigma, echoed his fears: “I never imagined this could happen. If nothing urgent is done, Nigeria will see a surge in new infections.”
For many Nigerians, the cost of ARV treatment is prohibitive. A recent study estimated that treatment could cost between $100 (₦149,248) and $1,000 (₦1,492,480) per month, making it unaffordable for most patients.
Nigeria Allocates ₦4.8 Billion for Emergency HIV Treatment
In response to the crisis, the Nigerian government has approved ₦4.8 billion (over $3 million) for the procurement of 150,000 HIV treatment packs, offering a temporary relief measure for the next four months.
“This allocation ensures that those on ARVs will continue to receive treatment without interruption,” said Minister of Health and Social Welfare Ali Pate after the Federal Executive Council (FEC) meeting.
The government has also formed a high-level task force, including officials from Finance, Budget, Defence, Environment, and the Nigeria Governors Forum, to develop a long-term HIV/AIDS sustainability strategy.
This approach includes:
- Strengthening domestic HIV/AIDS budgets
- Expanding local pharmaceutical production of ARVs
- Securing additional funding from European donors and private sector partners
U.S. donations account for most of the global funding for the U.N. program, which operates in 70 countries and leads global efforts to end AIDS as a public health threat by 2030.
Trump’s administration stated that it is reviewing all foreign aid programs to ensure they align with the “America First” policy.
With millions of lives at risk, the suspension of PEPFAR funding has exposed the fragility of Africa’s HIV/AIDS response. While Nigeria, South Africa, and Ethiopia scramble to find alternative solutions, the uncertainty surrounding U.S. foreign aid threatens to reverse decades of progress in the fight against HIV/AIDS.
Global health experts warn that if PEPFAR funding is not reinstated, the world could face a resurgence of HIV/AIDS, with millions of preventable deaths on the horizon.
For now, patients, activists, and governments wait anxiously, hoping for a lifeline before it’s too late.
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