Integrating Gender and Conflict Sensitivity into HIV Programming: A Pathway to Sustainable Health System Strengthening in ACE 3 States, Nigeria

HIV remains a pressing public health challenge in Nigeria, which ranks third globally in the number of people living with HIV. Persistent gender inequalities, conflict-related disruptions, and weak health systems threaten the sustainability of epidemic control. This study examines how integrating gender- and conflict-sensitive approaches into HIV programming contributes to sustainable health system strengthening. Using a qualitative case study design, the research draws on secondary data, program reports from the USAID-funded ACE3 programme, and relevant literature (Accelerating the Control of HIV epidemic project in Nigeria Cluster 3 (Kebbi, Sokoto and Zamfara States). The analysis is guided by Connell’s Theory of Gender and Power, conflict transformation theory, and the WHO health system strengthening (HSS) framework. Findings reveal that gender integration strategies—such as youth-friendly clinics, community dialogues, and differentiated service delivery—enhanced uptake, retention, and viral suppression among adolescents and women. Conflict-sensitive approaches, including civil society mediation and decentralised care models, ensured continuity of HIV services in fragile contexts. These interventions aligned with WHO’s HSS building blocks, strengthening service delivery, workforce capacity, information systems, and governance. The study concludes that embedding gender and conflict sensitivity into HIV programming not only improves biomedical outcomes but also promotes equity, resilience, and sustainability. Two key recommendations emerge: institutionalising gender- and conflict-sensitive models into Nigeria’s national HIV strategy and investing in CSO partnerships to sustain service delivery in fragile contexts. Future research should explore long-term financing mechanisms and how gender-transformative programming contributes to peacebuilding. Ultimately, HIV responses that integrate equity and resilience principles are essential for sustainable health systems in fragile and high-burden settings.