People with HIV groan as hospitals run out of test kits

FILE: Kits for HIV self testing

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Funding cuts by the United States Government are taking a heavy toll on Nigeria’s HIV response, as PUNCH Healthwise investigations reveal acute shortages of HIV test kits in public  hospitals and clinics nationwide. The  scarcity persists despite the Federal Government’s repeated assurances of increasing domestic funding and its pledge to end AIDS as a public health threat by 2030. JANET OGUNDEPO reports

When Danladi Adamu woke up on January 20, 2025, he had no idea that a single announcement would drive a sword deep into his heart.

That morning, news broke that the United States Government had paused all foreign assistance, a decision that immediately threatened the flow of life-saving HIV medicines and treatment to many countries, including Nigeria.

Being a Person Living with HIV for over 25 years, the news felt like a verdict as fear engulfed him.

“Those of us who follow the news closely rushed to our treatment centres immediately to confirm if the report was true,” Adamu recounted, frustration clear in his voice.

“Many of us turned up even though it wasn’t our appointment day, hoping we could get extra medication before things got worse,” he told PUNCH Healthwise.

The situation created chaos and psychological trauma.

‘The announcement brought a lot of psychological trauma to us. Till now, we are yet to recover,’ Adamu, who lives in Bauchi State, said.

Adamu, a member of the Network of Persons Living with HIV/AIDS, expressed thanks that despite the initial panic, he and other PLHIV continued to get their drugs.

However, the bigger challenge came when several test kit requests received no corresponding response.

Unarguably, the reality of the funding cuts had finally hit them.

Further confirming the situation to PUNCH Healthwise is the Bauchi State NEPWHAN coordinator, Abdullahi Ibrahim.

He lamented that while there has been stability in the availability of ARTs, testing kits remain inadequate.

“We ran out of test kits in November, and as of this month, the test kits are not available,” Ibrahim said.

He stated that this had slowed down efforts to engage in community testing, further impeding efforts to achieve the 95-95-95 global target to end AIDS by 2030.

“If we are running out of these test kits, the goal that 95 per cent of the population should know their status would not be achieved.

“But when we write to persons who are in charge or have the means to supply the test kits, we would be told that they are not available. This is a great problem because the spread of the virus would be more since many people now do not know they are HIV positive,” Ibrahim said.

The Bauchi NEPWHAN coordinator noted that the situation has left them to only test for HIV in pregnant women, leaving a gap in the general population.

PUNCH Healthwise findings further reveal that Bauchi, one of the states in the North-eastern geopolitical zone, was not alone in the scarcity of HIV test kits.

No test kit, many problems

A TB/HIV Specialist, Dr Dan Onwujekwe, asserted that testing is the entry point of HIV care, stating that the lack of access to free test kits poses a lot of problems.

He stated that the scarcity of test kits began after the funding cut announcement, stressing that since then, access to HIV testing had become a challenge.

Onwujekwe said, “Testing is the entry point to HIV care. And if we don’t have these kits as the first point of access, particularly if they are not free of charge in some places, then we have a problem.

“If we are not able to test and identify people with HIV and make access trouble-free, the virus is going to spread. Just like TB, that’s also related to HIV. At times, people are not able to test. We have had this shortage of test kits since the Trump administration. I don’t know whether they have corrected that. But it’s not as smooth as before. You have to identify the disease in the individuals, quantify the burden, and then other responses will follow. For both epidemics, we are in trouble if we don’t correct this issue of the deficiency of test kits.”

The funding crisis

The United States Government slashed its foreign aid budgets soon after Donald Trump took office on January 20 as the 47th US president.

Under Trump, the US government halted funding for the US President’s Emergency Plan for AIDS Relief (PEPFAR), a global health investment introduced in 2003. With the halt in funding for  HIV response, counselling initiatives and programmes, including testing, education, and community support, have been affected in countries like Nigeria that rely heavily on foreign donors for their HIV response.

According to UNAIDS, PEPFAR has saved more than 26 million lives and averted almost five million new HIV infections by investing in critical HIV prevention, treatment, care, and support programmes in 55 countries. As of December 2024, over 20 million people, including about 560,000 children, were receiving life-saving antiretroviral treatment through the programme.

UNAIDS warned that the discontinuation of the HIV programmes would lead to an additional 6.6 million new HIV infections and 4.2 million AIDS-related deaths globally.

An estimated two million Nigerians are living with HIV, with children making up a significant and vulnerable segment of this population, according to the National Agency for the Control of AIDS.

The funding cuts, HIV experts and advocates who spoke to PUNCH Healthwise say, would further impede the progress in achieving the 95-95-95 global goal to end AIDS by 2030.

The goals seek to ensure that 95 per cent of people know their status, 95 per cent of those diagnosed get sustained antiretroviral therapy, ART, and 95 per cent of those on treatment achieve viral suppression, effectively stopping transmission and improving health.

Viral load suppression means that the ART has lowered the amount of HIV in the blood to an undetectable level, preventing transmission and improving immune function.

HIV, the World Health Organisation says, has no cure. It is only treated with antiretroviral drugs to stop the virus from replicating in the body.

Since the January 20 announcement, PUNCH Healthwise reports that the Federal Government of Nigeria, through NACA, approved a $200 million intervention fund to bridge the funding gap.

The FG also established the Presidential Initiative for Unlocking the Healthcare Value Chain to promote domestic production and boost local manufacturing of ARV and diagnostic test kits.

However, findings by PUNCH Healthwise reveal that while PLHIV have uninterrupted access to life-saving medication, there is a scarcity of test kits for the general population, a scarcity of second and third-line drugs and paediatric ARTs.

Also, since the January 20 announcement, the fear of the withdrawal of other donors has been a constant companion of PLHIV in the country. Although the FG and states have picked up the programmes, they express concern that the services may not be as good as those provided by international donors.

The United Nations Children’s Fund has warned that 1.8 million children could die of AIDS-related causes by 2040 unless countries urgently scale up HIV services for mothers, children and adolescents.

UNICEF raised the alarm in its statement to commemorate World AIDS Day 2025, lamenting that shrinking funding and persistent gaps in early diagnosis and treatment were putting millions of young lives at risk.

According to recently published UNICEF-UNAIDS modelling, if programme coverage declines by half, an additional 1.1 million children could acquire HIV and another 820,000 could die by 2040, pushing the total toll among children to three million infections and 1.8 million deaths.

UNICEF Associate Director of HIV and AIDS, Anurita Bains, said the world had been making progress before abrupt global funding cuts disrupted essential services, warning that ending AIDS in children is now in jeopardy. She said countries moved quickly to mitigate the impact of funding disruptions, but without focused action, decades of gains risk being reversed and millions of young lives could be lost.

To further examine the impact of the funding cuts on HIV response across the country, PUNCH Healthwise spoke to People Living with HIV and the coordinators of the Network of Persons Living with HIV and AIDS across the six geopolitical zones in the country.

NEPWHAN is the umbrella body representing all people living with HIV in Nigeria.

All PLHIV who spoke to PUNCH Healthwise are open about their status and gave consent for their names to be used.

A few test kits in the South East

Findings by PUNCH Healthwise in Enugu and Anambra States also reveal inadequate test kits in the SouthEast Region.

News of the funding crisis hit a PLHIV in Anambra State, Amaka Adindu, like a sudden blow. The reality of the situation unravelled when test kits and other commodities dried up like the January harmattan wind.

“In the facility, drugs that were usually given for six months began to be reduced to two weeks. The cost of transportation to the centres at that short time was distressing. The care workers paid by the donors stopped work. It was a tough time in January,” Adindu said.

Gradually, the drugs became more available and were dispensed for three months to clients.

“But the challenge we are having now is the unavailability of test kits. Sometimes, we’re only given a few quantities, and it is usually limited to those coming to the facilities,”  the Anambra NEPWHAN coordinator told PUNCH Healthwise.

She called on the government to take up and sustain HIV intervention programmes in the country.

In Enugu, the NEPWHAN coordinator, Lilian Agbo, said the funding withdrawal created a gap in the HIV programmes in the state, leading to worry and emotional trauma among PLHIV.

She stated that while the FG’s intervention helped in ensuring continuous access to drugs, the dearth of test kits in the state has posed a challenge.

Agbo stated that while the combo test kits were available, they were limited.

She further noted that the cost of chemistry testing, that is, kidney/liver monitoring tests for PLHIV, has become a challenge, calling for increased government intervention.

Funding crisis vs test kits South-South

NEPWHAN coordinator for Rivers State, Blessing Chigozim, said the funding cut did not affect the availability and accessibility of drugs, but there has been a reduction in the number of months given to each client.

As with other states, test kits have become hard to come by.

“Test kits are no longer available as they used to be. Before you can talk about those who need treatment, they need to get tested. The mandate of NEPWHAN as a network is community engagement, so the lack of test kits for the community leaves them out,” Chigozim said.

She further stated that the situation has left many residents unaware of their status.

The Rivers NEPWHAN cord stated that the community focus was on PMTCT, emphasising the need for sustainability of HIV programmes.

She also fears for the future of PLHIV if the ad hoc staff of the donor partners leaves, pleading with the government to absorb the staff working in the facilities.

UNAIDS confirms situation

UNAIDS country update on the impact of the US funding cuts shows that over 95 per cent of community workers received stop-work orders, though about two-thirds have been recalled. The report confirmed that while immediate access to antiretrovirals remains stable, testing and case-finding activities have stalled significantly.

PUNCH Healthwise reports that activities for the 2025 World AIDS Day on December 1 were affected by the funding crisis, with a lack of test kits hindering the community testing programme, a highlight of the day’s event.

Troubling situation in Jigawa, North West

Aside from the nationwide scarcity of test kits, the funding crisis has led to the dearth of paediatric ARTs.

“The funding crisis has cut off the procurement of test kits by the partners about six months ago. The government is now the one providing test kits. The government’s response is making us afraid because the funders are leaving by March next year,” Abdullahi Ibrahim, the Jigawa State NEPWHAN coordinator, said.

Continuing, he said, “There are complaints from some facilities, even in Jigawa State, that there are no drugs, most especially paediatric drugs. The partners were telling us that they were expecting a supply since last month, but have yet to get it and have no idea when it will be supplied. We have informed the Deputy Governor of the state and the partners. They assured me that the drugs would be provided before December 15.”

The Jigawa State NEPWHAN cord mentioned that PLHIV are being enrolled in the state’s health insurance programme, and a trust fund has been launched for philanthropists and companies’ corporate social responsibility programmes to contribute and ensure the sustainability of the HIV programmes.

FCT faces scarcity of second-line drugs, testing kits

To feel the pulse of the funding cuts in the North Central, PUNCH Healthwise spoke with the NEPWHAN coordinator of the Federal Capital Territory, Peter Ikiti.

He mentioned that while the first-line ARTs were available, many PLHIV using the second and third line ARTs were finding it difficult to get their medications.

“We do not have a problem with the first-line drug. For a very long time now, we have had an issue with the accessibility of the second and third-line drugs,” he said.

Speaking on PLHIV who are supposed to receive and use the second and third line of drugs, Ikiti said, “Everyone should be placed on first-line drugs, but in a situation where the first-line drug fails, it will now be switched over to second-line drugs, which are a bit different from first-line drugs.

“And when that one also fails, it can now be migrated to third-line drugs. These are higher levels of drugs.”

The TB and HIV Specialist, Onwujekwe, explained that second-line drugs are given to PLHIV when treatment failure and resistance have been identified with the first-line drugs.

The implications of the scarcity of second and third line ARTs, Onwujekwe said, “Means people will remain on a failing regimen for longer than necessary. Thus, the virus will not be controlled, and if behavioural change is not practised, then resistance to the virus will change. And that means that in the near future or far future, we will have strains in circulation that we cannot control and treat.”

The FCT NEPWHAN coordinator further revealed that getting the testing kits has become difficult, describing the situation as “an issue of emergency action.”

Ikiti further lamented the disengagement of some members due to the funding cuts, stating that the source of income of such PLHIV has been disrupted, leading to malnutrition.

He accused the government of focusing mostly on treatment and prevention while neglecting care and support, which, he said, are needed to work together to achieve a holistic HIV intervention.

“Then, there are the other areas of intervention that are actually carried out effectively to become a comprehensive intervention. But, unfortunately, what we see at the moment is the treatment and the prevention. Care and support actually get to the background to the level that nobody cares about those who are dying due to malnutrition, particularly for the indigent ones,” Ikiti said.

The FCT NEPWHAN urged the government to intervene and ensure indigent PLHIV have access to proper nutrition, while upscaling the availability of testing kits and second and third-line ARTs.

Low funds, reduced outreach

Outreach activities are important for PLHIV. Outreach programmes are part of the measures to achieve the 95 per cent of people living with HIV know their status goal.

In Borno, another North-Eastern State, the situation is slightly different. The NEPWHAN coordinator, Maina Shettima, stated that although ARTs and test kits are available, the funding cuts led to reduced outreach activities, as there “was no fuel for the cars, so they were parked and some of the drivers are no longer around.”

NEPWHAN coordinator for Gombe State, Mohammed Sabo, says that although they have access to ARTs and test kits, the care workers and manpower are not available. He called on the state government to adopt short-term hired care workers to ensure PLHIV in the state have continuous access to the service providers.

Mixed response in South West

Findings from the South West reveal that while some states have test kits and access to drugs, some are battling with “no test kits.”

For example, in Oyo State, the HIV programme suffered a major breakdown in early 2025 following the US “stop-work order,” which disrupted drug access, halted testing, locked up the state drug warehouse, and crippled service delivery.

The NEPWHAN coordinator, Faith Olawale, said that although drug supply has since stabilised, the state still faces a critical shortage of HIV test kits and can no longer conduct essential kidney and liver monitoring for patients.

“Everybody is assessing treatment and other services, but in our state, we don’t have adequate kits. So, most of our members who go to the communities don’t have these kits,” Olawale said.

Available drugs, PrEP in Lagos

The situation in Lagos State is positive. The Lagos NEPWHAN Coordinator, Mr Patrick Akpan, said that ART and test kits were available and accessible in the state.

Akpan, who has lived with the virus for over 20 years, said that despite the funding cuts, the US government has not stopped giving medication.

“Treatment, that is, drugs, is one of the things they retain. So it’s still coming from the American government. It is other activities that relate to prevention, like PrEP, that have been stopped.

“Issues of care and support are the areas that they are not supporting. Some of the care and support meetings that we had before, all those programs like support groups where people living with HIV meet together to learn about the treatment and all that, most of them are no longer being supported. So these are some of the things that actually have been stopped,” the Lagos NEPWHAN coordinator said.

PrEP is a prophylaxis that is being given to people to prevent them from contracting the virus.

He further noted that Lagos State, “has taken up the issue of PrEP and responsibility to fund it. They didn’t stop completely; they only said that it can only be given to pregnant women or discordant couples. But now the Lagos State Government has decided to open it up for everyone.

“So the Lagos state government has made provision for people to walk into general hospitals and get PrEP services.”

Efforts to get the comment of the NEPWHAN National Coordinator, Abdulkadir Ibrahim, were unsuccessful as PUNCH Healthwise learnt that he was attending the ICASA Conference in Ghana.

Lack of testing kits strains HIV control – Experts

A Researcher on HIV and TB Management Control at the Ebonyi State University, Abakaliki, Prof Lawrence Ogbonnaya, said funding challenges continue to weaken Nigeria’s health system.

He stated, “Generally, there is very poor funding for health in Nigeria, and it affects what the health system can deliver. You can imagine controlling HIV/AIDS if you cannot conduct testing and know the status of people.”

The professor of Community Medicine explained that the epidemic is sustained by undiagnosed and undisclosed infections.

He emphasised that testing remains the first and most critical step in controlling the disease.

“So, controlling HIV/AIDS begins with being able to test and identify that you are positive. Once a person tests positive, then the person begins treatment because science has demonstrated that early treatment helps reduce transmission. It reduces the propensity for the person to transmit to other people,” the don said.

Ogbonnaya said donor cuts have affected progress, saying, “So, the cutting of donors has seriously affected our work and our ability to sustain the gains we made with HIV/AIDS response. So, what we are even praying for is that our international partners will keep their promise of continuing to supply the ART drugs to those who are already on it, because it will be a real calamity and crisis if we now begin to lack drugs.”

‘Lack of paediatric ARTs troubling’

The don described the lack of paediatric ARTs as troubling, stating that, “Now, concerning pediatric ARTs, generally, there is a serious under-reporting of pediatric cases of HIV. And that is because we are not able to routinely do any infant diagnosis.  If a mother is positive and delivers a baby, that baby will undergo Early Infant Diagnosis to see if the baby is positive. So, we can place that child on treatment immediately.”

Speaking on the reasons for the neglect of paediatric PLHIV, Ogbonnaya criticised the lack of advocacy for children living with HIV, despite their being part of vulnerable populations.

“It is usually said that pregnant women and children are vulnerable populations, but nobody is speaking for the children. Apart from those of us who are healthcare workers speaking for them, the children cannot talk for themselves,” the professor of Medicine said.

He further emphasised the need for increased funding, stating that persistent funding gaps could cause the country to lose the war on HIV.

“HIV cases will increase, both among children and adults, that is the implication. And that will be a very serious matter,” the HIV/TB expert said.

Also speaking, a former Principal Investigator, AIDS Prevention Initiative Nigeria, Harvard PEPFAR, Onwujekwe, emphasised the need for government intervention, stating that the continuous reliance on donors had to stop.

“We cannot always rely on donors, and these things are becoming glaring in our country,” the former Research Fellow at the Nigerian Institute of Medical Research, Yaba, Lagos, asserted.

Offering solutions, the TB/HIV specialist stressed the need for local manufacturing of the test kits, calling for an end to the dependence on imported test kits.

“I don’t see why we cannot manufacture test kits by now. We must think about a holistic approach. We can’t always depend on imported test kits. By now, we should be able to produce our own test kits that are sensitive, specific, and like every other one.

“It’s been over 40 years since the pandemic started. By now, we should have test kits, homemade, so that we’re not talking about imported test kits. It’s the same thing with drugs. By now, we should be having our own production of drugs. We should be self-sufficient in homemade test kits, homemade drugs, and I’m sure we have capable facilities and hands that can do these things locally. It can be done, there’s no rocket science anymore,” Onwujekwe said.

NACA keeps mum

Efforts to obtain NACA’s reaction were unsuccessful, as the agency’s Head of Public Relations and Protocol, Mrs. Toyin Aderibigbe, told our correspondent that the Director-General, Dr. Temitope Ilori, the official best positioned to address the issue was out of the country.

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