Donor Government Funding for HIV Falls

July 9, 2020
Gianna Melillo
Gianna Melillo

Gianna is an assistant editor of The American Journal of Managed Care® (AJMC®). She has been working on AJMC® since 2019 and has a BA in philosophy and journalism & professional writing from The College of New Jersey.

A recent analysis conducted by the Kaiser Family Foundation and The Joint United Nations Program on HIV/AIDS found donor governments spent $7.8 billion for HIV in 2019, a decrease of $165 million from the previous year. This number is similar to that spent a decade ago, despite a 25% increase of individuals now living with HIV in regions receiving the aid.

A recent analysis conducted by the Kaiser Family Foundation and The Joint United Nations Program on HIV/AIDS found donor governments spent $7.8 billion in current US dollars for HIV in 2019, a decrease of $165 million from the previous year. This number is similar to that spent a decade ago, despite a 25% increase of individuals now living with HIV in regions receiving the aid.

“After a steep rise in donor government funding for HIV between 2002, the start of new global HIV initiatives, and 2008, the onset of the global financial crisis, funding plateaued and has since fluctuated over much of the last decade,” authors write. In 2018, donor government disbursements to combat HIV totaled $8 billion.

The annual report outlines donor government funding for HIV care, treatment, and prevention in low- and middle-income countries. Donor contributions to the Global Fund to Fight AIDS, Tuberculosis, and Malaria (Global Fund); UNITAID; and UNAIDS were also included in the report.

Researchers found the decline was mainly driven by a decrease in bilateral funding from the United States, due to flat funding from Congress for several years, a shrinking funding pipeline for programs, and timing of disbursements. The 2019 government shutdown also delayed funding disbursements for a period.

In 2019, Canada, Denmark, the European Commission, France, the Netherlands, and Sweden all decreased their total funding. After accounting for inflation and exchange rate fluctuations, a decline was still evident.

“While donors increased multilateral contributions to the Global Fund, UNAIDS, and UNITAID by more than $100 million, these gains were not enough to offset declines in bilateral funding,” researchers noted. Germany, France, Ireland, Italy, and Japan all increased their funding while Australia and Norway remained consistent.

Because of decreased bilateral support for HIV, trends show decreases of more than $1 billion in funding from donor governments, apart from the United States, since 2010.

In addition, to reach 2020 global Fast-Track targets, which include widespread status awareness and treatment, UNAIDS estimates needed resources amount to $26.2 billion. Currently, only $19.8 billion is available.

However, despite these declines the United States remains the largest donor to HIV, after adjusting for economy size. The United States disbursed a total of $5.7 billion in 2019, followed by the United Kingdom, France, and the Netherlands.

When it comes to assessing relative contributions of donor governments, the United States ranks first by share of total donor government funding for HIV, by share of total resources available for HIV compared with share of the global economy (measured via gross domestic product), and by funding for HIV per $1 million US dollars in GDP.

Future funding for HIV remains uncertain. Researchers note US Congressional appropriations “have been essentially flat,” while the President’s Emergency Plan for AIDS Relief (PEPFAR) funding pipeline has diminished. PEPFAR was established in 2003 and is led by the US Department of State’s Office of the US Global AIDS Coordinator and Health Diplomacy.

Confounding the issue, the coronavirus disease 2019 pandemic has resulted in economic crises around the world, likely putting pressure on existing budgets.

“Every dollar not invested today contributes to AIDS-related deaths and new HIV infections,” said Winnie Byanyima, executive director of UNAIDS. “In a world characterized by massive inequalities we must ramp up investments for realizing the right to health.”