Donor Government Funding for HIV in Low- and Middle-Income Countries in 2019
This report provides an analysis of donor government funding to address HIV in low- and middle-income countries in 2019, 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), UNITAID, and UNAIDS. Key findings include the following:
- DONOR GOVERNMENT FUNDING FOR HIV DECLINED BY ALMOST US$200 MILLION BETWEEN 2018 AND 2019. Disbursements were US$7.8 billion in 2019, down from $8.0 billion in 2018, in current U.S. dollars (the trend was the same even after accounting for inflation and exchange rate fluctuations). This decline was driven primarily by a decrease in bilateral funding from the U.S., and, to a lesser extent, declining bilateral funding from other donors. In total, seven donor governments, including the U.S., decreased total funding (Canada, Denmark, the European Commission, France, the Netherlands, and Sweden); six increased (Australia, Germany, Ireland, Italy, Japan, and the U.K.) and one was essentially flat (Norway). 1
- DECLINES IN BILATERAL DISBURSEMENTS, PRIMARILY FROM THE UNITED STATES, DROVE THE OVERALL TREND. Bilateral disbursements decreased by almost $300 million in 2019, from $6.0 billion in 2018 to $5.7 billion in 2019. Most of this was due to the U.S. decline (almost US$220 million), which resulted from a complex set of factors including flat U.S. appropriations, a diminishing funding pipeline for the last several years, and the timing of disbursements. Six other countries also decreased bilateral support (Canada, Denmark, the European Commission, the Netherlands, Sweden, and the U.K.), five increased (Germany, France, Ireland, Italy, and Japan), and two were flat (Australia and Norway). These trends were nearly identical after adjusting for inflation and exchange rate fluctuations, except for Norway and Sweden, which both increased in currency of origin.
- CONTRIBUTIONS TO THE GLOBAL FUND, UNITAID, AND UNAIDS INCREASED, BUT NOT ENOUGH TO OFFSET BILATERAL DECLINES. Contributions to multilateral organizations totaled US$2.1 billion in 2019 (after adjusting for an HIV share to account for the fact that the Global Fund and UNITAID address other diseases), an increase of more than US$100 million, compared to US$2.0 billion in 2018. These increases, however, were not enough to offset bilateral declines. Funding provided to the Global Fund was $1.8 billion in 2019, $99 million to UNITAID, and $178 million to UNAIDS. Eight donors, including the U.S., increased their multilateral contributions (Australia, Germany, Ireland, Italy, Japan, the Netherlands, the U.K., and the U.S.), while five decreased (Canada, France, Norway, Sweden, and the European Commission), and one remained flat (Denmark). These trends were nearly identical after adjusting for inflation and exchange rate fluctuations, except for France, Norway, and Sweden, which provided essentially funding similar to the previous year in currency of origin. 2
- DESPITE DECLINES, AND EVEN AFTER ADJUSTING FOR THE SIZE OF ITS ECONOMY, THE U.S. CONTINUES TO BE THE LARGEST DONOR TO HIV. In 2019, the U.S. disbursed US$5.7 billion, followed by the U.K. (US$646 million), France (US$287 million), the Netherlands (US$213 million), and Germany (US$180 million). The U.S. also ranked first when standardized by the size of its economy, followed by the Netherlands, the U.K., and Sweden.
- FUNDING FROM DONOR GOVERNMENTS FOR HIV IN 2019 WAS ESSENTIALLY THE SAME AS A DECADE AGO, DESPITE A 25% INCREASE IN THE NUMBER OF PEOPLE LIVING WITH HIV IN LOW- AND MIDDLE-INCOME COUNTRIES. After a steep rise in donor government funding for HIV between 2002, the start of new global HIV initiatives, and 2008, the onset of the global financial crisis, funding plateaued and has since fluctuated over much of the last decade. Moreover, without funding from the U.S., funding for HIV from other donor governments would have declined by more than $1 billion since 2010, attributable almost entirely to their decreased bilateral support for HIV. While they have increased their contributions to the Global Fund, these have not offset declines.
- FUTURE FUNDING FROM DONOR GOVERNMENTS FOR HIV IS UNCERTAIN, PARTICULARLY IN LIGHT OF THE ONGOING IMPACTS OF COVID-19. While donors pledged significant support for the Global Fund during its recent three-year replenishment conference, U.S. Congressional appropriations have been essentially flat and the PEPFAR funding pipeline has diminished. In addition, bilateral funding from all other donors continues to decline. Moreover, the impact of the COVID-19 pandemic and the resulting economic crisis, which began in 2020, on the HIV response has yet to be fully realized but will likely put significant pressures on existing budgets as donors struggle to address the crisis within their own borders.