Barring an urgent intervention by the federal government, millions of Human Immunodeficiency Virus (HIV) and Tuberculosis (TB) patients may be in for hard times over gross shortage of essential drugs and consumables nationwide.
The disruption in essential supply has lately been noticed across states in Nigeria following the United States’ partial suspension of foreign aid to developing countries.
President Donald Trump announced the freeze on his first day in office in January as part of a government spending review. The World Health Organisation (WHO) estimated that eight countries – six of them in Africa, including Nigeria, Kenya and Lesotho – risk running out of HIV drugs.
The Guardian’s findings show that the prediction is already a fact in local health facilities visited in the Federal Capital Territory (FCT), Nasarawa, Enugu, Rivers, Oyo, Osun, and Lagos states among others.
It was gathered that some clinics are currently rationing old stock, dispensing between one or three-month dosages of Antiretroviral (ARV) drugs to people living with HIV instead of the erstwhile six-month refill routine.
ARVs, test kits shortage hits facilities
Most of the squeezed facilities are supported by the Institute of Human Virology of Nigeria (IHVN) and Heartland Alliance, funded mainly by foreign aid and donor agencies.
At the Heart-to-Heart Unit in Wuse General Hospital, FCT, for instance, a health worker confirmed that there is currently a shortage of ARVs, thereby forcing supply rationing to people living with HIV (PLHIV).
“There is a limited supply of ARVs right now. We used to give three months of drugs and occasionally six months to patients. But right now, we are giving only one month of medication. We can only work with what we have,” the official muttered with a tinge of frustration.
At Asokoro District Hospital, about a 10-minute drive from Wuse, health workers at the Directly Observed Therapy (DOT) centre confirmed rationing supplies “to keep the facility running” in January.
Outside of the FCT, the narrative is not pleasant. A visit to the Rivers State University Teaching Hospital (RSUTH) and Rumuodomaya Primary Healthcare Centre in Obio-Akpor Local Government Area of Rivers State revealed significant reductions in free consumable giving to HIV and tuberculosis patients.
Findings showed that tuberculosis tests and screening, erstwhile provided free of charge, are now paid for. Besides, there have been no new drug supplies lately, causing a significant strain on what is left of old stocks.
Though the ousted civilian government in Rivers did promise to inject funds into HIV/AIDS and tuberculosis care services, it was learnt that the political chaos and seizure of local council allocations stalled the intervention, among others.
One of the patients at the HIV unit of RSUTH, Emelia, said: “We are scared and afraid for our lives (thinking of surviving without essential drugs). Our hopes are fading because before now, when we came to the hospital, they used to give us a complete dose of antiretrovirals that could sustain us for weeks. But now, they ration it, and sometimes they don’t give us any drug at all.”
Checks around medical facilities in Enugu, including the Asata Primary Health Centre and Uwani Health Centre, indicated that HIV/AIDS drugs and test kits are no longer available. It was gathered that such tests had not been conducted in the past four weeks.
A medical official at the Uwani PHC told The Guardian they had not run HIV/AIDS tests in the past three weeks due to lack of test kits. She stated that the last batch of drugs finished last month, adding that “it could not even serve the last set of patients who needed the drugs”.
“You know that since President Trump took over, some of those drugs that were donated have stopped coming in. So, anywhere you see them, they are sold at exorbitant rates. I don’t think any facility will dispense those drugs free of charge now because they are scarce,” the official said.
The Enugu State Chairman of the Nigeria Medical Association (NMA), Dr Sunny Okafor, however, said that the University of Nigeria Teaching Hospital (UNTH) still administers free-of-charge, stressing that the German government funds the services.
Ilogbo PHC in Ogbomoso South Local Government Area of Oyo State is, however, not as lucky. An official of the facility, Dr Abel Ojo, said the shortage is affecting everyone. “HIV patients do not have drugs to collect. For TB, there are still drugs, but we don’t know if we will get restocked. We are not sure of the supply. This has affected the immunisation plans for the children with children missing National Immunisation Plus Days.”
The complaint is the same at Oke-Ilewo PHC in Abeokuta, Ogun State. Some restless patients complained about not getting drugs for some time now. In Ondo State, a top medical officer confirmed that they had stopped giving out antiretroviral drugs because there were no supplies in Akure.
“In fact, there is no PHC that has drugs to offer. The shortage started in February. People have been coming, but we have been telling them they (drugs) are not available now. Even if it is sold, I don’t think many people will be able to afford it because the price from the manufacturer is N85,000,” the officer said.
Shortage to worsen with Global Fund’s pull-out
Nigeria has nearly two million people living with HIV, with many relying on receiving aid-funded medicines. TB burden has an estimated 467,000 cases and 125,000 deaths as of 2021. Over 361,000 cases were reported in 2023.
Trump’s executive order paused foreign aid support for an initial duration of 90 days (in January) in line with his “America First” foreign policy. The order has affected health programmes globally, leaving shipments of critical medical supplies, including HIV drugs, greatly hampered.
WHO chief Tedros Ghebreyesus warned that the disruptions to HIV programmes could undo 20 years of HIV/AIDS and TB progress. It could also lead to more than 10 million additional cases of HIV and three million HIV-related deaths, he added, noting this was “more than triple the number of deaths last year”.
The Network of People Living with HIV/AIDS in Nigeria (NEPWAN) noted that the U.S. government, through the President’s Emergency Plan for AIDS Relief (PEPFAR), had been supporting HIV response in 33 states and the Federal Capital Territory (FCT). In comparison, the Global Fund supports four states: Anambra, Ebony Gombe, and Kwara.
Sadly, the Global Fund has also given notice that it will stop supporting Nigeria by 2030 and may start winding down by 2026. The association, therefore, warned that HIV response in 33 states and the FCT being supported by PEPFAR are under threat if nothing is done urgently.
ARVs for sale
NEPWAN Senior Programme Officer confirmed that the ARVs were scarce last month (February), adding that people took advantage of the situation, including pharmacists in the facilities, to sell the ARVs for as much as N40,000 before the intervention of the National Agency for the Control of AIDs (NACA).
The officer cautioned that the commercialisation of ART is a potential danger to the HIV response as many people cannot afford it.
“We have been talking of sustainability, but unfortunately, the Nigerian government and leaders have been paying lip service to it. Global Fund notified us that by 2030, they would stop supporting us as a country, and by 2026, they would start winding down. They discussed a sustainability plan: by 2026, some state governments should begin taking responsibility ahead of 2030.”
A Mentor Mother working in one of the PHCs in Nasarawa State, Queen Kennedy, affirmed that many facilities have run out of Antiretroviral Therapy (ART) stock even before President Trump’s Executive order.
Kennedy explained that the ARVs were never sold in the facilities, but stipends had to be collected from beneficiaries for logistics. She said: “Logistics was a constraint because most people working in the ARV clinics are under the IHVN, and not under (Nigerian) government. After Trump’s Executive order, we were told that the account had been frozen, and many of us (workers) did not get paid.
“For me, I just got my January salary four weeks ago. So, the movement for drug collection (on behalf of the patients) was a constraint. For somebody going to pick drugs for people, he will ask the patients to bring a little token so that he could use it to transport himself. I think that was why the money was being collected. Nobody is commercialising ART, but there are no drugs.”
She noted that at some point, they were directed to stop collecting viral load samples, adding that they just resumed collection last week. She fears that most people working in the ART clinics nationwide may lose their jobs if nothing is done. She appealed to the federal government to fully take ownership of the HIV response.
Kennedy also disclosed that pre-exposure prophylaxis (PrEP) was unavailable except for facilities with some stock before President Trump pulled the plug on medical freebies.
No cause for alarm – FG
On the contrary, the National Coordinator of the Association of Women Living with HIV (ASHWAN), Esther Hindi, told The Guardian that Antiretroviral drugs are still available, but “facilities are being cautious of giving them out”.
“This is because we don’t know what will happen in the next two months before the executive order is withdrawn. What will be the next step and the effect? Already, the federal government has committed to procuring more drugs. So, the usual six months given has been reduced to three months. The executive order did not stop the treatment component,” Hindi assured.
She admitted that because the HIV response in Nigeria is donor-driven, with PEPFAR contributing the largest percentage of the support for HIV response in the country, service delivery has been affected, but the treatment component is still ongoing.
On the allegations that HIV drugs are being sold, Hindi said: “I will not be surprised because sometimes when you go to the pharmacy, the common drugs like anti-malaria, that are being given to hospitals for pregnant women, you will see pharmacies selling them with ‘Not for sale’ emblem on them. So, if people report that antiretroviral drugs are being sold in the pharmacy, there should be evidence to prove that. The pharmacies have the right to sell, but it should not be the one that donor agencies give for free,” Hindi said.
Minister of Health and Social Welfare, Prof. Mohammed Ali Pate, has also assured that the federal government was addressing all funding and policy gaps to tackle the challenges in the nation’s healthcare system, especially in the face of the cut in funding by the United States .
He noted that although the U.S. decision was sudden, it reduced the various measures initially put in place by the federal government through policies and interventions.
“We appreciate the contribution of the U.S. government, the billions of dollars of U.S. government and U.S. people’s resources that help, but the responsibility to provide for the country is on us immediately.
“And that while we appreciate what has happened in the past, now we have to look at how we orient ourselves to improve and continue so that no Nigerian who is doing technical care will go without treatment for HIV, malaria or other conditions,” Pate said.
(The Guardian)
