Financing the Response to AIDS in Low- and MiddleIncome Countries: International Assistance from Donor Governments in 2010

Introduction

The last decade saw a dramatic rise in resources devoted to addressing the HIV epidemic in low- and middle-income countries, contributing to significant scale up of treatment and prevention efforts. In marking the 30th year of the epidemic, UNAIDS recently reported that treatment access had increased more than 20 times and new infections fell by nearly 25% over the decade.¹

While resources from all sectors – multilateral institutions; the private sector; and low and middle income country governments and the households and individuals within them – have been key to this scale-up, international assistance by donor governments has been one of the most critical, accounting for most of the funding for HIV in many hard hit countries. Donor governments provide assistance through both bilateral aid and contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) and other financing channels such as UNITAID (the international drug purchase facility).

Despite the rise in resources, UNAIDS estimates a resource gap of US$6 billion annually.² Additionally, the decade of funding increases by donors to combat the HIV/AIDS epidemic appears to be over in the wake of the global economic crisis. After flattening for the first time in 2009, donor government funding for HIV/AIDS fell in 2010. While some of decline is due to exchange rate fluctuations, there were real decreases by several donors. This raises questions about the future of the response to the epidemic, and will be important to monitor over time.

Each year, UNAIDS and the Kaiser Family Foundation collect and analyze data to document international assistance for AIDS in low- and middle- income countries.³ This latest report provides data from 2010, the most recent year available. As such, it represents funding levels reflecting budgeting decisions that occurred during the aftermath of the global economic crisis. The analysis is based on data provided by governments – including the Group of Eight (G8), Australia, Denmark, Ireland, The Netherlands, Norway, Spain, Sweden, and other donor government members of the Organisation for Economic Co-operation and Development (OECD)’s Development Assistance Committee (DAC) – as well as from the European Commission (EC). It includes bilateral assistance and contributions to the Global Fund and UNITAID.

Key Highlights

Funding for international AIDS assistance provided by donor governments declined by 10 percent over the 2009- 2010 period, marking the first time year-to-year support has fallen in more than a decade of tracking efforts:

• Disbursements (actual resources available in a given year) were US$6.9 billion in 2010, compared to $7.6 billion in 2009 (see Chart 5).The decrease primarily reflects reductions in direct bilateral funding by several governments as well as currency fluctuations.
• The drop in funding for the AIDS response between 2009 and 2010 comes after years of significant increases.Disbursements rose by more than six-fold between 2002 and 2008 before leveling in 2009, and dropping in 2010 (see Chart 5).
• In 2010, funding provided to the Global Fund totalled US$2.9 billion, of which US$1.6 billion (or 56%) represents an adjusted “AIDS share” (see Chart 8). Funding for UNITAID totalled US$318 million, of which US$173 million (54.4%) represents an adjusted “AIDS share”.

As has been shown in prior year reports, most international assistance to combat the epidemic is provided bilaterally, although funding channels vary by donor.

• Bilateral assistance as identified for purposes of this analysis (which includes funding earmarked for AIDS through multilateral instruments, such as UNAIDS), accounted for 74% of disbursements in 2010 (US$5.1 billion, see Chart 7); the remainder was provided multilaterally through the Global Fund and UNITAID.
• Funding channel patterns vary significantly by donor (see Chart 9).
• Other international financing sources include multilateral institutions such as U.N. agencies, multilateral development banks such as the World Bank, and the private sector.

1. UNAIDS, AIDS at 30: Nations at the crossroads, June 2011.  ↩︎
2. UN General Assembly, Political Declaration on HIV/AIDS: Intensifying our Efforts to Eliminate HIV/AIDS, A/RES/65/277, June 2011.  ↩︎
3. See, Kaiser Family Foundation, http://www.kff.org/hivaids/7347.cfm.  ↩︎