Financing the Response to HIV in Low- and Middle-Income Countries: International Assistance from Donor Governments in 2013

Executive Summary

2013 brings a mixed story for donor government funding to address the HIV epidemic in low- and middle-income countries.  Funding commitments fell to US$8.07 billion, a 3% drop from 2012.  The drop is primarily due to decreasing annual commitments by the United States government, the largest donor to HIV in the world. At the same time, disbursements (resources made available to the field) increased in 2013 to US$8.46 billion (8% over 2012), largely the result of a 2013 spending acceleration by the U.S. government of accumulated prior-year funding commitments (the U.S. is the only government carrying such substantial balances forward); without this acceleration, disbursements would have been essentially flat. Several donor governments also increased their contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), representative of a recent shift from bilateral HIV to multilateral channels. Even with increasing disbursements in 2013, there still remains a gap between available resources and estimated need.  In addition, future funding remains uncertain – U.S. bilateral HIV commitments have declined in recent years, and are currently below 2008 levels, and there is a diminishing pipeline of prior-year funding. 

The Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Kaiser Family Foundation have been tracking bilateral donor government assistance for HIV in low- and middle-income countries as well as contributions to the Global Fund and to UNITAID by the 29 donor government members of the Organization for Economic Co-operation and Development’s (OECD) Development Assistance Committee (DAC) since 2002 and this report presents the most recent data available.

Key findings include:

• In 2013, the most recent year for which there are data, donor government commitments for HIV fell to US$8.07 billion, a 3% drop from 2012.  The drop is primarily due to decreasing annual bilateral funding commitments by the U.S. government.  At the same time, disbursements for HIV increased by nearly US$600 million (an 8% increase) to US$8.46 billion (see Figure 1), largely the result of the U.S. accelerating disbursement of bilateral funding from prior years.  Without the U.S. increase, disbursements would have remained essentially flat.
• In addition to the U.S., four of the 14 governments assessed (Australia, Denmark, France, and the U.K.) also increased disbursements for HIV in 2013, compared to 2012, although increases by Denmark, France and the U.K. follow prior year declines bringing their 2013 totals back to earlier funding levels. Five donor governments (Germany, Ireland, Norway, Sweden, and the European Commission) remained constant (after exchange rate fluctuations are taken into account), and three other governments decreased funding (Canada, Italy, and Japan). While HIV assistance from the Netherlands also decreased, it was due to a shift in support from bilateral HIV funding to the Global Fund.
• The U.S. was the largest donor in 2013 (US$5.6 billion) accounting for approximately two-thirds (66.4%) of donor government disbursements for HIV. The U.K. was the second largest donor (10.0%) followed by France (4.8%), Germany (3.4%), and Denmark (2.3%).
• While most international assistance for HIV is provided bilaterally (US$6.4 billion or 76%), five donor governments provided a majority of funding in 2013 through multilateral channels (Global Fund and UNITAID): France (88%), European Commission (81%), Canada (70%), Japan (69%), and Germany (53%). Looking more broadly over the past several years, many donors appear to be shifting an increasing share of their HIV assistance from bilateral programs to the Global Fund. As the Global Fund provides support for three diseases – HIV, TB, and malaria – this could result in a decreasing share of funding for HIV over time.
• In 2013, several donor governments provided a greater share of funding to HIV than their share of the world’s GDP:  the U.S., the U.K., Sweden, and Denmark. However, when standardized by the size of their economies (GDP per US$1 million), Denmark ranks first followed by the U.S., the U.K., Sweden, and Ireland.
• UNAIDS estimates that global HIV funding available from all sources – domestic public and private spending, donor government bilateral assistance, multilateral organizations and private philanthropic aid disbursements – totaled US$19.14 billion in 2013.¹ However, this remains well below the projected need to address HIV of US$22 to US$24 billion by 2015.²

1. UNAIDS, preliminary estimate of resources available from all sources, 2014. This estimate includes domestic expenditures (public and private) for all low- and middle- income countries, including five countries that transitioned into high income levels in 2013. ↩︎
2. UNAIDS, 2013 UNAIDS Report on the Global AIDS Epidemic, September 2013. ↩︎