Donor Government Funding for HIV in Low- and Middle-Income Countries in 2022
Key Findings
UNAIDS, “Global AIDS Update Report”, July 2023.
In 2022, some donor governments provided COVID-specific emergency contributions to the Global Fund and UNITAID in addition to their contributions for core activities. Specifically, Canada, France, Germany, and Japan provided COVID-specific funding to UNITAID, while the European Commission, Germany, the Netherlands, New Zealand, Portugal, the U.K., and the U.S. provided COVID-specific funding to the Global Fund. For the purposes of this report, these COVID-specific amounts have been excluded as they cannot be attributed to a specific area, such as HIV.
Donor government contributions to the Global Fund and UNITAID have been adjusted for an HIV-share to account for the fact that these multilateral organizations address other diseases and areas (see Methodology).
U.S. totals represent funding amounts provided through regular appropriations only. In 2021, the U.S. Congress appropriated additional emergency supplemental funding for bilateral HIV activities and for the Global Fund to address the impacts of the COVID-19 pandemic. These emergency supplemental funding amounts are not included in overall U.S. totals.
In addition to the US$6.1 billion disbursed for HIV in 2022 (provided through regular appropriations for bilateral programs as well as the HIV-adjusted share of contributions to the Global Fund and UNAIDS), the U.S. disbursed an additional US$78.2 million for bilateral HIV activities from emergency supplemental funding that was provided in response to the COVID-19 pandemic through the “American Rescue Plan Act of 2021” (see KFF analysis of “Global Funding Across U.S. COVID-19 Supplemental Funding Bills”).
Per direct communication with Swedish International Development Cooperation Agency (SIDA): “Swedish SRHR aid fell by 16% in between 2021 and 2022. This was the result of a reprioritization in the state budget following Russia’s invasion of Ukraine.”
Global Fund, “Global Fund Board Hails Record-Breaking Seventh Replenishment Final Outcome of US$15.7 Billion”, November 2022.
UNAIDS, “Global AIDS Update Report”, July 2023.
Report
Donor government disbursements are a subset of overall international assistance for HIV in low-and-middle-income countries, which also includes funding provided by other multilateral institutions, UN agencies, and foundations.
KFF & UNAIDS, “Donor Government Funding for HIV in Low- and Middle-Income Countries in 2022”, July 2022.
UNAIDS, “Global AIDS Update Report”, July 2023.
UNAIDS estimates that US$20.8 billion was available for HIV from all sources (domestic resources, donor governments, multilaterals, and philanthropic organizations) in 2022, expressed in 2019 USD. For purposes of this analysis, this estimate was converted to 2022 USD, or US$22.4 billion. In addition, while the amounts presented in this analysis include donor contributions to multilateral organizations, the UNAIDS estimate of total available resources for HIV includes the actual disbursements made by multilateral organizations in 2022 rather than the donor government contributions to these entities.
The donor share of total available resources includes bilateral disbursements as well as an adjusted share of Global Fund and UNITAID disbursements (the donor government share of contributions to each of the multilaterals in 2022 is applied to the disbursements from these multilaterals for the same year).
The UNAIDS resource needs estimate is expressed in 2019 USD.
In addition to the US$6.1 billion disbursed for HIV in 2022 (provided through regular appropriations for bilateral programs as well as the HIV-adjusted share of contributions to the Global Fund and UNAIDS), the U.S. disbursed an additional US$78.2 million for bilateral HIV activities from emergency supplemental funding that was provided in response to the COVID-19 pandemic through the “American Rescue Plan Act of 2021” (see KFF analysis of “Global Funding Across U.S. COVID-19 Supplemental Funding Bills”).
KFF, “The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR)”, April 2023.
In 2022, 54% of the Global Fund’s disbursements and 46% of UNITAID’s disbursements were directed to HIV activities. These percentages were applied to the full donor government contributions to these multilateral organizations to calculate the “HIV-share” (see Methodology for additional details).
UNAIDS, “Global AIDS Update Report”, July 2023.
Global Fund, “Global Fund Partners Pledge Record Level of Support to End Deadly Diseases, Prevent Future Pandemics”, September 2022.
Methodology
Per direct communication with the German Agency for International Cooperation (GIZ): “In general, Germany supports systemic approaches such as the One Health approach and health systems strengthening through both multilateral and bilateral engagement. In addition to supporting a smaller number of projects that address individual diseases, Germany takes a horizontal, systemic approach by supporting health systems strengthening in general. Efficient health systems are a prerequisite for realizing the human right to the ‘highest attainable standard of physical and mental health.’ Strengthening health systems is therefore the overarching approach to the strategy of German development cooperation in the health sector and is prioritized over funding activities that address individual diseases.”
Per direct communication with Ireland Department of Foreign Affairs: “The data for 2022, which shows a decrease against 2021 expenditure, is a result of a revised assessment methodology of estimated HIV/AIDS expenditure.”
Per direct communication with the U.K. Foreign, Commonwealth & Development Office (FCDO): “The FCDO Annual Report and Accounts 2021 to 2022 explained that the department’s ODA spending plans needed to be revisited to ensure all ODA-eligible spending was managed within 0.5% of GNI. This was in the context of the significant and unexpected costs incurred to support the people of Ukraine and Afghanistan escape oppression and conflict and find refuge in the UK, alongside wider migration pressures. We remain committed to protecting the most vulnerable and returning to spending 0.7% of GNI on ODA as soon as the fiscal situation allows. The FCDO’s latest estimate of its ODA spending for 2022-23 is £7,572m. The FCDO’s indicative ODA budget for 2023-24 is £8,095m. FCDO ODA allocations for these years are set out in the Minister for Development’s 30 March Written Ministerial Statement.”