Introduction

Financing a sufficient and sustained response to the HIV/AIDS epidemic in low- and middle- income countries has emerged as one of the world’s greatest challenges, and one that will be with us for the foreseeable future. International assistance from donor governments, through bilateral aid and contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria as well as other financing channels, is a critical part of this response. Other international financing sources include multilateral institutions and the private sector. Domestic spending by many affected-country governments to combat their epidemics, as well as spending by households and individuals within these countries, are also major parts of the response. Funding from all these sources has risen over the past decade. Despite these increases, however, the difference between UNAIDS’ estimates of resource needs compared to resources available in 2006 was US$6 billion, a difference that could even grow larger over the next few years. Most of this difference will need to be filled by the international community.

This analysis provides the latest available data on international assistance for AIDS in low- and middle- income countries provided by donor governments, including the Group of Eight (G8), the European Commission (EC), Ireland, the Netherlands, Sweden, Switzerland, and other donor governments who provide international development assistance. The data were collected and analyzed through a collaborative effort between UNAIDS and the Kaiser Family Foundation. The Center for Strategic and International Studies also conducted research for this project.

Key Highlights

In 2006, international AIDS assistance from the G8, EC, and other donor governments reached its highest level ever: ƒ

• Commitments totalled US$5.6 billion, of which US$4.5 billion was provided through bilateral channels (including earmarked multilateral commitments) and US$.943 billion to the Global Fund (adjusted to represent an AIDS share).
• The equivalent of seven in ten commitment dollars was disbursed in 2006 (including current and past commitments), totalling US$3.9 billion in resources made available for AIDS in low- and middle-income countries.

Funding from donor governments has risen significantly over the past several years:

• Between 2002 and 2006, commitments and disbursements each increased more than three-fold, although commitments rose at a faster rate than disbursements.
• Between 2005 and 2006, commitments rose by 28% and disbursements by 11%.

Increases in international AIDS assistance from donor governments have been driven by a subset of G8 Members and, notably, a few non-G8 Members:

• In 2006, the United States was the largest donor in the world, accounting for close to half (47%) of funding commitments by governments and 41% of disbursements. Among resources available for the fight against AIDS in low-and middle- income countries from all sources (domestic and international) in 2006, the U.S. accounted for 18%, the largest share.
• The Netherlands accounted for the second largest share of commitments from all donor governments and third largest share of disbursements in 2006. The United Kingdom accounted for the second largest share of disbursements. Sweden and Ireland each accounted for larger shares than some G8 Members.

Most funding provided by donor governments is channelled bilaterally or earmarked through multilateral instruments, accounting for 76% of disbursements in 2006; the remainder is provided through the Global Fund. Funding channel patterns vary significantly by donor.

UNAIDS estimates that US$14.9 billion was needed to address the epidemic in low- and middle- income countries in 2006:

• Of this, an estimated US$8.9 billion was available from all sources (public and private), with donor governments accounting for 44% (US$3.9 billion in disbursements).
• The U.S., U.K., and the Netherlands accounted for the largest shares of assistance funding.
• Still, there was a gap of US$6.0 billion between resources available from all sources and resources needed in 2006.

Assessing “fair share” in the context of international assistance is a challenging task and there is no single, agreed upon methodology for doing so. Two different methodologies used in this analysis indicate that, in 2006:

• While the U.S. government provided the bulk of international assistance for AIDS, it provided a smaller share of all resources available for AIDS (from donor governments, multilaterals, the private sector, and domestic sources) than the U.S. share of the world’s economy (as measured by gross domestic product or GDP). This was also the case for Canada, France, Germany, Italy, and Japan. The U.K., the Netherlands, Sweden, and Ireland each provided greater shares of all resources for AIDS than their shares of GDP.
• When standardized by GDP per US$1 million, to account for differences in the sizes of government economies, the Netherlands provided the highest amount in 2006, followed by Sweden and Ireland. The U.K. was fourth and the U.S., fifth.

This survey finds that, with a July 1 implementation milestone approaching, most Massachusetts residents support a new state law to provide health coverage to almost all residents, including the individual mandate that requires residents to obtain coverage or pay a penalty.

The poll, conducted by the Kaiser Family Foundation, the Harvard School of Public Health and the Blue Cross Blue Shield of Massachusetts Foundation, finds support for the new health insurance law has increased. In this recent poll, two-thirds (67%) of state residents who have heard of the new health insurance law support it, compared with 16% who oppose it. In a poll conducted September 2006, six in 10 residents (61%) who had heard of the law said they supported it.

In addition, more than half (57%, compared to 52% in September) say they support the law’s individual mandate requirements, compared with 36% who oppose it.

Residents who support the law mainly say it is because they believe “it is the right thing to do” (90% of those who support say this is a major reason) and because they believe broader coverage will keep costs down by providing more incentives for preventive care (79%). Among the small group of residents who oppose the law, most say people shouldn’t be required to buy insurance if they can’t afford it (72%) or if they don’t want it (61%).

The random-sample telephone poll of 1,003 residents was conducted between May 29 and June 10 and has a margin of error of plus or minus 4 percentage points for results based on the full sample. The margin of error is higher for results based on subgroups.

News Release

Chartpack

Toplines

These toplines provide the detailed results from the June 2007 Kaiser/Harvard/BCBSMA Foundation poll of Massachusetts residents on the new health reform law.

Toplines (.pdf)

On June 28, 2007, Foundation Vice President Tricia Neuman testified before the House Budget Committee about Medicare Advantage plans and their implications for beneficiaries.

Testimony (.pdf)

This chartpack highlights key results from the June 2007 Kaiser/Harvard/BCBSMA Foundation poll of Massachusetts residents on the new health reform law.

Chartpack (.pdf)

This brief analyzes health insurance coverage and access for low-income non-citizen adults and discusses provider insights into the obstacles this population faces in obtaining coverage and receiving care. Overall, non-citizen adults account for just under one-fourth of all non-elderly uninsured adults. Low-income uninsured adults are at particularly high risk for being uninsured due to very limited access to both private and public coverage.

The brief finds that, largely due to their high uninsured rate, low-income non-citizen adults have very poor access to care. Although they have more limited access to care, low-income non-citizen adults are not relying on the emergency room for their care. Instead, many rely on clinics and health centers.

Issue Brief (.pdf)

Massachusetts’ law to cover their uninsured population combines an individual mandate on the purchase of health insurance with government subsidies to ensure affordability. Full implementation of the plan is expected by July 1, 2007. This fact sheet summarizes the plan and its implications.

Fact Sheet (.pdf)

Providing health coverage for the entire family can both help to increase coverage of children and assist low-income families in obtaining more affordable health care services. This brief uses data from the 2005 Kaiser Low-Income Coverage and Access Survey to examine health coverage, access and the financial impacts of health care for low-income parents and their families.

Issue Brief (.pdf)

The Global HIV Prevention Working Group issued its fifth report, Bringing HIV Prevention to Scale: An Urgent Global Priority.

The Global HIV Prevention Working Group is an international panel of more than 50 leading public health experts, clinicians, biomedical, and behavioral researchers, advocates and people affected by HIV/AIDS, convened by the Bill & Melinda Gates Foundation and the Kaiser Family Foundation. This is the fifth report released by the Working Group.

News Release

Executive Summary (.pdf)

Full Report: Bringing HIV Prevention to Scale: An Urgent Global Priority (.pdf)

From a Global Perspective: Interview with Helene Gayle

Dominic Chavez, photographer, and John Donnelly, reporter, Washington bureau, The Boston GlobeExamine the effectiveness of public and private U.S. funding and programs to help AIDS orphans in Africa

Sheri Fink, M.D., freelance reporter, New York City Medical care in times of crisis and disaster, focus on New Orleans, post-Katrina

Deborah Franklin, acting deputy science/health editor, National Public Radio, Washington, D.C. Genetic testing and its implications for individuals and their health insurance coverage

Felice J. Freyer, medical writer, The Providence Journal, Rhode Island The causes and costs of premature births

Tom Jennings, documentary producer, New York City Immigrant health issues, migrant workers, and health policies related to immigration

Watch the documentary “Seeking Cures With No Prescription” (New York Times, 10/10/08)

Joshua Norman, health reporter, The Sun Herald, Biloxi, Mississippi Mental health and trauma recovery in the Gulf region Read Josh’s blog, “Post Katrina Mental Health“

“Resiliency After Trauma Can Lead to Spiritual Growth” (Sun Herald, 12/24/07) “Traumas Can Lead to Spiritual Growth” (Sun Herald, 12/23/07) “Katrina’s Aftermath: news with no end in sight” (Nieman Reports, Fall 2007 Issue) “Resiliency Training Aims to Improve First Responders’ Coping” (Sun Herald, 10/13/07)

Czerne M. Reid, health and science reporter, The State, Columbia, South Carolina Federal and state funding for HIV/AIDS treatment and care, and the economic and social impact of the disease in South Carolina

T.R. Reid, Rocky Mountain bureau chief, The Washington PostA comparative analysis of other countries’ health care financing and delivery systems and the lessons for the U.S.

“Sick Around the World” (Frontline, April 2008)

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