HIV Prevention Drug-Lenacapavir
Susan Abayomi
On June 13, 2026, Channels TV reported that Nigeria and 61 other countries have been affected by major funding cuts for HIV prevention, based on early data presented by UNAIDS. Across those 62 countries, 38% fewer people received pre-exposure prophylaxis, or PrEP, at least once in 2025 compared to 2024. That is a decline of 1.2 million people, from 3.3 million to 2.1 million, with Nigeria, Cameroon, and Uganda among the countries seeing sharp drops. Funding for condoms fell by more than 90% in some places, and in Nigeria condom distribution dropped by 55% between December 2025 and March 2026.
UNAIDS Executive Director Winnie Byanyima called this “perhaps the most serious disruption of HIV services since the HIV response started” and described it as the “biggest storm the HIV response has ever seen.” She said the cuts, combined with shrinking civic space and increased criminalisation of marginalised populations, have come together to undermine prevention efforts. Global development assistance fell by 23% in 2025, the sharpest drop on record, and HIV testing programmes dropped by 22% in high-burden settings between 2024 and 2025. The result is that prevention was hit harder than treatment, and key populations were the worst affected because they depended on tailored services by community leaders that were often the first to go.
In Nigeria specifically, the number of people accessing PrEP fell from 43,000 in November 2024 to below 6,000 in April 2025, according to Bright Oniovokukor, a coordinator of the Civil Society for HIV/AIDS in Nigeria. Surveys in nine African countries also showed steep declines in Nigeria, Togo, and Uganda. Almost one quarter of 56 countries surveyed in late April 2025 reported having less than six months of condom or PrEP stocks, and almost half reported supply chain management difficulties. These gaps matter because every week 3,000 adolescent girls and young women in sub-Saharan Africa acquire HIV, and incidence in this group runs three to four times higher than among their male peers.
The funding crunch stems largely from reductions by major donors. The United States, which accounted for 75% of international HIV funding, temporarily halted all HIV-related funding earlier in 2025 after President Donald Trump’s inauguration. Other donors have also scaled back, with European countries citing defense spending linked to the Ukraine war. PEPFAR funding cuts led to more than 8,000 staff involved in HIV programmes losing their jobs and thousands of PrEP users being lost in the system. In South Africa, 56% of facility staff surveyed reported reduced capacity after the PEPFAR withdrawal. WHO warned that disruptions to HIV programmes could undo 20 years of progress and lead to over 10 million new HIV cases and 3 million HIV-related deaths if not reversed. 
Despite the cuts, treatment programmes have proven more resilient than prevention. Globally, the number of people on antiretroviral drugs rose by 2.7% year on year to 32.1 million as of December 2025, though that was below the previous annual average increase of around 4%. UNAIDS said countries and communities stepped up to fill gaps on treatment and avert the worst-case scenario some had predicted. In Nigeria, volunteers went door-to-door to keep patients on medication, and community networks mobilized to deliver drugs when clinics shut. Still, testing was hit, with early figures showing more than a million fewer people tested for HIV in 2025 than 2024, meaning cases may have been missed.
Nigeria’s government is responding with a new National HIV and AIDS Strategic Plan 2026–2030 aimed at shifting from donor dependence to a locally driven model. Launched in Abuja by NACA Director-General Dr Temitope Ilori, the plan emphasizes sustainability, country ownership, and integrating HIV interventions into healthcare, education, gender, and justice sectors. Ilori said the donor-dependent model is no longer sustainable with dwindling external funding. On February 3, 2026, the Federal Executive Council approved N4.8 billion for 150,000 HIV treatment packs to cushion the impact of shrinking donor support. A new U.S.-Nigeria health agreement for 2026-2030 commits $2.1 billion from the U.S. and $3 billion from Nigeria, with Nigeria taking over funding in full over five years.
The cuts come just as powerful new prevention tools are emerging. Lenacapavir, a twice-yearly injection proven to be up to 100% effective in preventing HIV infection, reached just over 6,000 people across five sub-Saharan African countries by March 2025, against the 20 million people UNAIDS estimates need antiretroviral-based prevention. In September 2026, Nigeria joined a global deal announced at the Clinton Global Initiative to cut the cost of lenacapavir from $28,000 to $40 per person annually. NACA’s Dr Ilori called it a “turning point” that could unlock affordable access to transformational prevention for millions at risk. The gap between the potential of such medicines and access remains one of the starkest examples of how innovation alone doesn’t solve medicines access issues.
UNAIDS warns that the funding crisis threatens to reverse years of gains. Between 2010 and 2024, annual AIDS-related deaths fell 54% to 630,000 and new infections dropped by 40%. But Byanyima said the “funding crisis has exposed the fragility of the progress we fought so hard to achieve.” With 40.8 million people living with HIV and 1.3 million new infections reported in 2024, UNAIDS is working with at least 30 countries to improve domestic financing. Still, she noted the gap cannot be closed immediately. For Nigeria and the other 61 countries, the challenge is maintaining prevention services for the most vulnerable while transitioning to sustainable, country-led responses in a far harsher funding environment.
