Donor Government Funding for HIV in Low- and Middle-Income Countries in 2018
This report provides an analysis of donor government funding to address HIV in low- and middle-income countries in 2018, the latest year available, as well as trends over time. It includes both bilateral funding from donors and their contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and UNITAID. Key findings include the following:
- DONOR GOVERNMENT FUNDING FOR HIV CHANGED LITTLE BETWEEN 2017 AND 2018. Disbursements were US$8.0 billion in 2018, compared to $8.1 billion in 2017, in current dollars (after accounting for inflation and exchange rate fluctuations, funding declined slightly in 2018 compared to 2017).1,2 Seven of 14 donor governments increased disbursements between 2017 and 2018 (Australia, Canada, France, Japan, the Netherlands, Norway, and Sweden), five declined (Denmark, Ireland, Italy, the U.K., and the U.S.; the U.S. decline was due to timing of Global Fund payments – see below) and two were flat (the European Commission and Germany).
- BILATERAL SUPPORT FROM DONORS DECLINED SLIGHTLY IN 2018. Bilateral disbursements decreased by $163 million in 2018, to $6.2 billion compared to $6.3 billion in 2017. Four donors increased bilateral support (Australia, Canada, the Netherlands, and Sweden), five decreased (Denmark, Ireland, Italy, the U.K. and the European Commission) and five were flat (France, Germany, Japan, Norway, and the U.S.).
- CONTRIBUTIONS TO THE GLOBAL FUND AND UNITAID REMAINED STEADY. These totaled US$1.8 billion (after adjusting for an HIV share to account for the fact that the Global Fund and UNITAID address other diseases), compared to US$1.7 billion in 2017. Funding for the Global Fund was $1.7 billion; funding for UNITAID was $103 million. Nine of 14 donors increased their multilateral contributions, while one, the U.S., decreased and four remained flat (Canada, Germany, Ireland and the Netherlands). The U.S. decline was due to timing of payments and is expected to reach the same level as the prior year.
- THE U.S. CONTINUES TO BE THE LARGEST DONOR TO HIV, EVEN AFTER ADJUSTING FOR THE SIZE OF ITS ECONOMY. In 2018, the U.S. disbursed US$5.8 billion, followed by the U.K. (US$605 million), France (US$302 million), the Netherlands (US$232 million), and Germany (US$162 million). The U.S. also ranked first when standardized by the size of its economy, followed by the Netherlands, Denmark, and the U.K.
- FUNDING FROM DONOR GOVERNMENTS IN 2018 WAS SIGNIFICANTLY BELOW ITS PEAK IN 2014. Funding from donor governments rose rapidly from 2002 through 2008, marking the start of major new global HIV initiatives. It leveled, and even decreased, at the onset of the global financial crisis. After a short rebound, it reached its peak in 2014. Funding in 2018 was more than $600 million below 2014 levels.
- OVER THE PAST DECADE, FUNDING FROM DONOR GOVERNMENTS, OTHER THAN THE U.S., DECLINED. Since 2010, HIV funding from donor governments, other than the U.S., declined by more than $1 billion, against a backdrop of budget constraints in the aftermath of the global financial crisis, as well as rising refugee and other humanitarian emergency costs. Most of the decline ($945 million) can be attributed to decreased bilateral support for HIV. However, while there were some increases in total funding provided to the Global Fund (for all three diseases) by these donors, they did not offset bilateral declines, and their overall UNITAID contributions went down. Moreover, after adjusting for an HIV share, multilateral contributions also declined over the period.
- FUTURE FUNDING FROM DONOR GOVERNMENTS FOR HIV IS UNCERTAIN. If these trends continue, future funding from donor governments is likely to remain stable at best and will hinge largely on future U.S. support as well as the next three-year replenishment period for the Global Fund. In the case of the U.S., Congressional appropriations in 2019 were essentially flat, and the PEPFAR funding pipeline has diminished, which could lead to decreasing bilateral disbursements over time. There is also uncertainty about the U.S. pledge to the Global Fund, although the Congress has indicated its intention to increase support.3 Most recently, the U.K. also pledged to increase its support as well.4 Still, UNAIDS estimates that there is a gap of several billion dollars between resources available from donor governments and others, and the amount needed to address HIV and that gap is growing.5