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Donor Government Funding for HIV in Low- and Middle-Income Countries in 2016

Introduction

Despite significant progress in combatting HIV1, driven in large part by increased investments, the epidemic remains a global emergency and several challenges threaten future progress.2  One such challenge is an ongoing resource gap; UNAIDS estimates that although US$19.1 billion from both international and domestic sources was available to address HIV in low- and middle-income countries in 2016,3 US$26.2 billion will be needed annually by 2020 (to be gradually reduced by 9% by 2030) to meet global targets to end AIDS as a global public health threat by 2030.4  While funding from all sources is critical to achieving further progress, funding from donor governments represents a significant share5 of the total and is particularly important in the lowest income countries.

This report provides the latest data on donor government resources available to address HIV in low- and middle-income countries.  It is part of a collaborative effort between UNAIDS and the Kaiser Family Foundation that began more than a decade ago, just as new global initiatives were being launched to address the epidemic.  This current report provides data on donor government disbursements in 2016, the most recent year available. It includes data from all members of the Organisation for Economic Co-operation and Development (OECD)’s Development Assistance Committee (DAC), as well as non-DAC members where data are available.  Data are collected directly from donors, the Global Fund, and UNITAID, and supplemented with data from the DAC.  Fourteen donor governments that account for 98% of total disbursements are profiled in this analysis.  Both bilateral assistance and multilateral contributions to the Global Fund and UNITAID are included.6  See methodology for more detail.

Figure 1: Donor Government Disbursements for HIV, 2002-2016

Findings

Donor government funding for HIV in low- and middle-income countries declined by $511 million in 2016, dropping from US$7.5 billion in 2015 to US$7.0 billion in 2016 (-7%), as measured in current U.S. dollars (Figure 1, Table 1, Appendix). This marks the second successive year of declines, and brings disbursements to their lowest level since 2010.

This follows almost a decade of rapid rise; between 2002 and 2008, funding rose steeply and significantly following the launch of the Global Fund and the creation of the President’s Emergency Plan for AIDS Relief (PEPFAR), the U.S. global HIV/AIDS program.  Funding, however, then began to flatten after the global economic crisis hit in 2008.  After several years of mostly flat funding, decreases began last year, against a backdrop of constrained aid budgets.

Table 1: International HIV Assistance from Donor Governments (bilateral & multiateral), 2009-2016 (current USD in millions)
Government 2009 2010 2011 2012 2013 2014 2015 2016
Australia  $99.9  $104.5  $111.1  $124.7  $144.0  $100.4  $98.7  $78.0
Canada  $129.9  $136.1  $147.3  $154.5  $141.4  $124.6  $109.3  $95.5
Denmark  $193.3  $171.4  $205.6  $171.0  $191.7  $167.2  $138.8  $106.5
France  $348.6  $407.6  $412.7  $375.2  $409.8  $302.8  $263.1  $242.4
Germany  $397.9  $305.8  $303.7  $288.5  $285.3  $278.4  $200.9  $182.0
Ireland  $81.2  $81.9  $76.2  $60.5  $59.8  $51.4  $36.4  $31.1
Italy  $9.5  $11.4  $5.1  $13.9  $2.4  $25.6  $19.7  $26.0
Japan  $141.8  $157.1  $84.9  $209.1  $101.6  $175.9  $117.9  $113.2
Netherlands  $381.9  $350.5  $322.3  $193.5  $186.4  $218.7  $177.9  $214.2
Norway  $130.2  $119.4  $119.1  $115.3  $118.4  $123.6  $108.3  $72.9
Sweden  $171.8  $140.7  $164.0  $170.8  $172.5  $154.4  $109.2  $111.8
United Kingdom  $779.0  $890.9  $971.2  $800.1  $842.1  $1,114.0  $899.9  $645.6
United States  $4,434.9  $3,722.0  $4,506.6  $5,022.3  $5,620.8  $5,571.9  $5,004.6  $4,912.8
European Commission  $118.1  $101.7  $123.2  $100.7  $100.6  $91.2  $92.7  $36.9
Other DAC  $237.2  $169.1  $74.3  $61.2  $83.2  $89.4  $74.5  $67.7
Other Non-DAC  $47.7  $13.7  $19.8  $20.9  $27.6  $32.1  $12.4  $16.9
Total  $7,702.9  $6,883.8  $7,647.1  $7,882.0  $8,487.5  $8,621.6  $7,464.4  $6,953.5

The 2016 decline is due to several factors: actual decreases in both bilateral and multilateral funding, accounting for an approximate net 50% of the decline; exchange rate fluctuations (20%); and the timing of U.S. contributions to the Global Fund (30%), due to U.S. law that limits its funding to one-third of total contributions to the Global Fund.  In constant (2014) dollars, overall funding also decreased, although by a smaller amount.

In 2016, 11 of the 14 donor governments profiled disbursed less funding for HIV compared to 2015, and 3 increased or remained essentially flat (Figure 2). In currency of origin, the pattern was nearly identical.

Figure 2: Percent Change in Donor Government Disbursements for HIV, 2015-2016 (current USD)

The U.S. was the largest donor to HIV efforts in 2016, providing $4.9 billion.  The second largest donor was the U.K. ($645.6 million), followed by France ($242.4 million), the Netherlands ($214.2 million), and Germany ($182.0 million).

Most funding is provided bilaterally (79%), including from the two largest donors – the U.S. and the U.K., though several others (Australia, Norway, Germany, Japan, Italy, France, and Canada) provide a larger share of their resources through multilateral channels (Figure 3).

Figure 3: International HIV Assistance: Funding Channels for Donor Government Disbursements (current USD), 2016

Bilateral Disbursements

Bilateral disbursements for HIV from donor governments – that is, funding disbursed by a donor on behalf of a recipient country or for the specific purpose of addressing HIV – totaled $5.5 billion in 20167, a net $108 million decline compared to 2015.  Nine of 14 donors profiled disbursed less bilateral funding in 2016 compared to 2015, and 3 increased.  In currency of origin, 7 donors disbursed less bilateral funding.8  The significant depreciation of the pound drove down U.K. disbursements when measured in dollars; in pounds, bilateral disbursements from the U.K. were flat compared to 2015.

PEPFAR disbursed $4.4 billion in bilateral funding in 2016, an increase of $69 million over 2015, after a decline in the previous year.9  That decline was largely due to timing, as the U.S. shifted and deferred funding to 2016 and beyond to account for the start-up of the DREAMS program, a $385 million partnership aimed to reduce HIV infections among adolescent girls and young women in 10 sub-Saharan African countries, and the expansion of voluntary medical male circumcision services in 14 Eastern and Southern African countries.10

Multilateral Contributions

Multilateral contributions from donor governments to the Global Fund and UNITAID for HIV – that is, funding disbursed by donor governments to these organizations which in turn use some of that funding for HIV – totaled $1.5 billion in 2016 (after adjusting for an HIV share), a decline of $403 million (22%) compared to 2015.  As noted above, some of this was an issue of timing on the part of the U.S. due to legislative limitations on Global Fund contributions (that funding was subsequently disbursed in 2017).11 However, some of the decline was due to donor decisions to front-load their funding early in the 2014-2016 Global Fund pledge period. Donor government contributions to UNITAID were also down slightly.12

Fair Share

Table 2 provides several different measures for assessing the relative contributions of donor governments, or “fair share” to HIV.  The question of “fair share” in the context of donor government funding for HIV is an important one. Yet such measurements are complex and there is no single, agreed-upon methodology for assessing fair share.  For example, a rank by total funding amount does not capture the relative wealth of a nation.  Yet a standardized measure including wealth does not take into account certain other donor policies that may inhibit or facilitate the amount of assistance such as tax subsidies for charitable giving.  The following measures are included here: rank by share of total donor government disbursements for HIV; rank by share of total resources available for HIV compared to share of the global economy; and rank by funding for HIV per US$1 million GDP. Each measure yields varying results:

  • Rank by share of total donor government funding for HIV: By this measure, the U.S. ranked first in 2015, followed by the U.K., France, and the Netherlands.
  • Rank by share of total resources available for HIV compared to share of the global economy (as measured by GDP): This measure compares donor government shares of total resources available for HIV in 2016 ($19.1 billion) to their share of the global economy. By this measure, 3 countries, the U.S., the Netherlands and Denmark, provided greater shares of total HIV resources than their shares of total GDP (Figure 4).
  • Rank by funding for HIV per US$1 million GDP: When donor government disbursements are standardized by the size of their economies (GDP per US$1 million), donors rank quite differently than when measured by actual disbursement amounts (Figure 5). Whereas Denmark ranked eighth in actual disbursements provided for HIV in 2016, it ranked number one when standardized by GDP. The U.S. ranked third.
Table 2: Assessing Fair Share Across Donors, 2016
Government Share of World GDP Share of Total Donor Government Funding for HIV1 Share of Global Resources Available for HIV2 Total HIV Funding Per $1 Million GDP
Australia 1.7% 1.1% 0.4% $61.9
Canada 2.0% 1.4% 0.5% $62.4
Denmark 0.4% 1.5% 0.6% $347.3
France 3.3% 3.5% 1.3% $98.4
Germany 4.6% 2.6% 1.0% $52.5
Ireland 0.4% 0.4% 0.2% $106.1
Italy 2.5% 0.4% 0.1% $14.1
Japan 6.6% 1.6% 0.6% $22.9
Netherlands 1.0% 3.1% 1.1% $277.8
Norway 0.5% 1.0% 0.4% $196.8
Sweden 0.7% 1.6% 0.6% $218.7
United Kingdom 3.5% 9.3% 3.4% $245.5
United States 24.7% 70.7% 25.7% $264.6
European Commission 0.5% 0.2%
Other DAC 1.0% 0.4%
Other Non-DAC3 0.2% 0.1%
1 – In 2016, donors provided an estimated $7.0 billion in international assistance (bilateral and multilateral) for HIV in low- and middle-income countries.
2 – UNAIDS estimates that $19.1 billion in total resources was available from all sources (domestic, donor governments, multilaterals, and philanthropic) in 2016.
3 – Represents Non-DAC member contributions to the Global Fund and UNITAID. Bilateral HIV funding from these donor governments is not currently available.

Figure 4: Donor Government Share of World GDP* Compared to Share of Resources Available for HIV, 2016

Figure 5: Donor Government Rank by Disbursements for HIV per US$1 Million GDP*, 2016

Conclusion

The continuing decline in donor disbursements for HIV, while due to several complex factors, raises challenges to reaching global HIV targets and ending AIDS as a public health threat by 2030. While some of the factors contributing the decline are temporary or based on global currency issues, there is some uncertainty in the future, particularly given the U.S. Administration’s recent calls to cut the global HIV budget by almost 20%.13  Although such cuts are unlikely to be fully supported by the U.S. Congress, they suggest downward pressure on funding from the largest donor to HIV in the world.  In addition, other donors continue to face competing pressures for their aid, which could explain why more than half of those profiled provided less for HIV in their currencies of origin in 2016 compared to 2015.  The next few years will be critical for making further progress on HIV by 2030; any delay in scaling up HIV interventions will result in additional HIV infections and deaths.14

Key Findings Methodology

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Filling the need for trusted information on national health issues, the Kaiser Family Foundation is a nonprofit organization based in Menlo Park, California.