From progress to precarity: how funding shifts threaten HIV gains in Nigeria.

Sustained financing remains critical to the global HIV response, particularly in low- and middle-income countries (LMICs) where external aid supports treatment and prevention programs. Recent shifts in donor priorities have raised concerns about the continuity of essential HIV services. Using Nigeria as a case study, this paper examines how declining international HIV funding threatens HIV control efforts through increased transmission risk, treatment interruption, and strain on fragile health systems. Available evidence indicates that funding reductions have disrupted community-based HIV testing, prevention, and care services, particularly those serving key populations including orphans and vulnerable children. Nigeria's Global Fund allocation fell by over 11%, while thousands lost access to pre-exposure prophylaxis within months of donor funding freezes. Modeling studies suggest that across LMICs, similar funding shortfalls could result in millions of additional HIV infections and deaths by 2030 if mitigation measures are not implemented. This commentary highlights the urgent need for diversified and sustainable financing mechanisms, strengthened domestic resource mobilization, and coordinated global action to safeguard HIV gains and sustain progress toward the Joint United Nations Programme on HIV and AIDS 2030 targets.