Financing the Response to HIV in Low- and Middle-Income Countries: International Assistance from Donor Governments in 2012

Executive Summary

As the United Nations General Assembly prepares to meet in New York in September 2013, with progress towards the Millennium Development Goals (MDGs) and the 2011 Political Declaration on HIV/AIDS on the agenda, it is important for the global HIV community to take stock of international efforts to finance the response to the epidemic. The world has marshaled significant resources to address HIV over the past decade, helping to achieve incredible results — since the MDGs were first launched in 2001, the number of people newly infected with HIV has dropped by 20% and access to antiretrovirals has increased more than 20-fold, reaching 9.7 million by the end of 2012.^1,2 

While funding from all sources — multilateral institutions, the private sector, charities, foundations, religious organizations, low- and middle-income country governments, and households and individuals — is integral to financing the response to HIV, international assistance from a subset of government donors has been critical to this effort. The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Kaiser Family Foundation have been tracking donor government assistance for HIV in low- and middle-income countries since 2002 and this report presents the most recent data available. As it shows, after a decade of significant growth, funding began to flatten with the onset of the global economic crisis in 2008 and, despite a slight increase this year, future funding levels are uncertain. In addition, there still remains a gap between available resources and estimated need.

Key findings include:

• In 2012, the most recent year for which there are data, donor government assistance for HIV totaled US$7.85 billion³ and, in real terms, remained essentially flat compared to 2011 (US$7.63 billion) continuing a trend of flat funding that began in 2008 (see Figure 1). This flatlining mirrors a similar trend in development assistance more generally, reflecting the economic and fiscal constraints of the post-financial-crisis period.⁴ 
• A slight rise in total nominal spending between 2011 and 2012 (3%) was driven largely by an increase in bilateral disbursements from the U.S. (10%) as well as increased contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) in fulfillment of replenishment commitments. These increases, however, are temporary and not expected to continue; in fact, commitments (enactments), fell in 2012. Thus, the future could show further flattening or even declines.
• Five of the 14 governments assessed (Australia, Canada, Japan, Sweden, and the U.S.) increased total assistance for HIV in 2012, while six others decreased funding (Denmark, France, Ireland, the Netherlands, the European Commission, and the U.K.), and three (Germany, Italy, and Norway) remained constant (after exchange rate fluctuations are taken into account).⁵
• The U.S. was the largest donor in 2012 (US$5 billion) accounting for nearly two-thirds of total donor government assistance for HIV. The U.K. was the second largest donor (10.2%) followed by France (4.8%), Germany (3.7%), and Japan (2.7%). The top five donors have generally accounted for most (approximately 80%) of total donor assistance for HIV over the last several years.
• In 2012, several donor governments provided a greater share of funding to HIV than their share of the world’s GDP:  the U.S., the UK, the Netherlands, Sweden, Denmark, and Ireland. However, when standardized by the size of their economies (GDP per US$1 million), Denmark ranks first followed by the U.K., Sweden, the U.S., and Ireland.
• Most (nearly $6 billion or 76%) international assistance is provided bilaterally, although channels of assistance vary by donor, with some providing most of their funding through multilateral mechanisms. In 2012, for example, four donor governments provided a majority of funding through the Global Fund and UNITAID: Canada (65%), the European Commission (70%), France (85%), and Japan (90%).
• UNAIDS estimated that global HIV funding from all sources (donor governments, domestic spending, multilateral organizations, and private institutions) totaled US$16.8 billion in 2012, of which 51% was provided by domestic resources, an X% increase above 2011 levels. Despite this increase, total resources available in 2012 were well below the UNAIDS estimated US$22 to US$24 billion in annual funding that will be needed by 2015 to address the impacts of HIV.

1. UNAIDS, 2012 UNAIDS Report on the Global AIDS Epidemic, November 2012. ↩︎
2. UNAIDS, Treatment 2015, July 2013. ↩︎
3. UNAIDS estimates that international assistance for HIV from all sources – donor governments reporting to the DAC, other donor governments, multilateral organizations, and private philanthropies – totaled US$8.9 billion in 2012 ↩︎
4. OECD, Aid to poor countries slips further as governments tighten budgets, April 2013. ↩︎
5. The U.K. decrease is largely attributable to a 2011 pre-payment of its 2012 Global Fund contribution. Otherwise, U.K. assistance for HIV remained essentially flat between 2011 and 2012. Similarly, the Japan increase in 2012 reflects a pre-payment of its 2013 Global Fund contribution and would have also remained essentially flat had the pre-payment not occurred. ↩︎