Financing the Response to AIDS in Low- and MiddleIncome Countries: International Assistance from Donor Governments in 2011

Introduction

After a decade of significant growth in donor government assistance to address AIDS in low- and middle-income countries, the world entered a financial crisis, raising concerns about the global effort to tackle the epidemic. While resources from all sectors – multilateral institutions, the private sector, low- and middle-income country governments, and households and individuals—are all key to financing the response, donor governments account for most HIV funding in many hard hit countries. Therefore, understanding how donors have responded to this crisis is critical to assessing efforts to address the AIDS epidemic around the world and in meeting the targets set out by United Nations Member States in the 2011 Political Declaration on AIDS.¹

UNAIDS and the Kaiser Family Foundation have been tracking donor government assistance for AIDS in low- and middle- income countries since 2002.² This latest report provides data from governments for 2011, the most recent year with comparable data available across donors. As it shows, international assistance rose sharply from 2002 through 2008, the period just before the onset of the economic crisis. It then began to flatten and, last year, for the first time, disbursements declined. The current report finds that although funding has gone back up, it remains at 2008 levels. If such trends continue, reaching the UN Political Declaration investment target of $22-24 billion needed by 2015 could be at risk.

This report is based on analysis of data provided by the 23 donor government members of the Organisation for Economic Co-operation and Development (OECD)’s Development Assistance Committee (DAC) and the European Union (EU). It includes their combined bilateral assistance and contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) and to UNITAID.

Key Highlights

Funding for international AIDS assistance provided by donor governments increased by more than six-fold between 2002 and 2008 but, other than a decline in 2010, has remained at this level through 2011:

• Disbursements were US$7.6 billion in 2011, compared to $6.9 billion in 2010. Funding was US$7.7 billion in both 2008 and 2009 (see Chart 5).
• The decline between 2009 and 2010 was largely attributed to the largest donor, the United States (U.S.) who had reported delays in disbursements during that period.³
• Commitments (enactments) have also been flat at approximately $8.7-$8.8 billion since 2008⁴ (see Chart 5).

As has been the case over the past decade, a subset of donor governments continues to account for the majority of OECD DAC government international AIDS assistance:

• In 2011, the United States (U.S.) was the largest donor in the world, accounting for more than half (59.2%) of disbursements by donor governments. The U.K. accounted for the second largest share of disbursements in 2011 (12.8%), followed by France (5.4%), the Netherlands (4.2%), Germany (4.0%), and Denmark (2.5%) (see Chart 6).
• Together, funding from the member countries of the EU and the European Commission (EC) totalled US$2.6 billion, accounting for 34% of disbursements by governments.

Two governments significantly increased their funding in 2011, compared to 2010, while seven essentially remained level and four decreased.

The U.K. reported significant funding increases following an explicit government policy decision to boost overall development assistance funding by approximately 40% over a three-year period.⁵

The increase by the U.S. from 2010-2011 brought their funding back up to 2009 levels, after a 16% decrease between 2009-2010.

Australia, Canada, Denmark, France, Germany, Norway and Sweden maintained or slightly increased funding while Ireland, Italy, Japan and the Netherlands decreased. Most donor government assistance for AIDS is provided bilaterally, although funding channels vary by donor.

• In 2011, bilateral government assistance accounted for US$5.8 billion (see Chart 7).
• Funding provided to the Global Fund to Fight AIDS, Tuberculosis and Malaria (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$263 million, of which US$137 million (52.2%) represents an adjusted “AIDS share”.
• Overall, 77% of international AIDS assistance in 2011 was provided bilaterally, and 23% multilaterally. While most donor governments provide the bulk of their assistance bilaterally, five (Canada, the EC, France, Germany, and Japan) channel at least half through the Global Fund and UNITAID (see Chart 9).
• Between 2009 and 2011, the UK significantly increased its contribution to the Global Fund (see Chart 10).
• Not all donor governments provided contributions to multilateral institutions. In 2011, for example, 6 members of the DAC did not contribute to the Global Fund, including Italy and Spain, several of whom have given in the past. In addition, only 6 contributed to UNITAID.⁶

One question that often arises is what constitutes a donor’s “fair share” of resources. Yet, assessing “fair share” in the context of international assistance is complex and there is no single, agreed upon methodology for doing so. Two different methodologies were used in this analysis:

• Share of Resources for AIDS Compared to GDP: In 2011, UNAIDS estimates that US$16.8 billion was made available from all sources (donor governments, multilaterals, the private sector, and domestic sources) for AIDS.⁷ Of this the U.S. provided 27%, the largest share of any donor and above its share of the world’s economy as measured by gross domestic product or GDP (22% in 2011). Denmark, Ireland, the Netherlands, Sweden, and the U.K. also provided greater shares of total AIDS resources than their shares of GDP (see Chart 11).
• GDP per US$1 Million: When donor government disbursements are standardized by the size of their economies (GDP per U.S.$1 million), donors rank quite differently than when measured by actual disbursement amounts. Whereas Denmark ranked sixth in actual disbursements provided for AIDS in 2011, it ranked number one when standardized by GDP. The UK ranked second by this measure (the same as for disbursement amounts), followed by the Netherlands, Ireland, and Sweden. The U.S. was sixth when standardized by GDP, compared to first when ranked by disbursement amount (see Chart 12)

1. UN General Assembly, Political Declaration on HIV/AIDS: Intensifying our Efforts to Eliminate HIV/AIDS, A/RES/65/277, June 2011. ↩︎
2. See, Kaiser Family Foundation, http://www.kff.org/hivaids/7347.cfm. ↩︎
3. The U.S. reported that delays in disbursements between 2009 and 2010 were due to new implementation requirements. ↩︎
4. Enactments are firm budgetary decisions that funding will be provided, regardless of the year in which it is disbursed. While most governments examined disburse enacted amounts significantly within the same year, the U.S. government, the largest donor, does not. Yet, because U.S. enactments are firm budgetary decisions, they provide an important point of comparison to other governments’ disbursement amounts. ↩︎
5. HM Treasury, Budget 2011, p. 48 and Budget 2012, p. 55. ↩︎
6. Based on analysis of the Global Fund’s Pledges and Contributions database and UNITAID’s 2011 Annual Report. ↩︎
7. UNAIDS, Together we will end AIDS, July 2012 ↩︎