Donor Government Funding for HIV in Low- and Middle-Income Countries in 2020
This report provides an analysis of donor government funding to address HIV in low- and middle-income countries in 2020, 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:
- IN A YEAR WHEN THE WORLD WAS UPENDED BY COVID-19, STRAINING COUNTRY ECONOMIES AND CHALLENGING THEIR HEALTH SYSTEMS, DONOR GOVERNMENT FUNDING FOR HIV INCREASED IN 2020. Disbursements were US$8.2 billion in 2020, an increase of US$377 million over 2019 (US$7.8 billion), in current U.S. dollars (funding was higher even after accounting for inflation and exchange rate fluctuations).
- HOWEVER, THIS WAS DRIVEN ALMOST ENTIRELY BY INCREASED U.S. CONTRIBUTIONS TO THE GLOBAL FUND DUE PRIMARILY TO THE DISBURSEMENT OF PRIOR-YEAR FUNDING. The U.S. contribution to the Global Fund totaled US$1.1 billion in 2020, an increase of US$540 million over 2019 (US$552 million), as funds appropriated in prior years were disbursed, which is not expected to continue at this level in 2021.1,2 Three other donors (Japan, Germany, and the U.K.) also increased their Global Fund contributions in 2020.3
- ADDITIONALLY, BILATERAL FUNDING FROM DONOR GOVERNMENTS OTHER THAN THE U.S. DECLINED IN 2020, CONTINUING A LONGER-TERM TREND. Bilateral disbursements decreased by almost US$100 million, from US$5.7 billion in 2019 to US$5.6 billion in 2020. Thirteen of 14 donor governments decreased their bilateral support; funding from the U.S. was flat. Since 2010, bilateral funding from donor governments other than the U.S. has declined by more than US$1 billion, while U.S. funding has remained at essentially the same levels.
- AS SUCH, THE U.S. IS NOT ONLY THE LARGEST DONOR TO HIV, EVEN AFTER ADJUSTING FOR THE SIZE OF ITS ECONOMY, IT IS CARRYING AN INCREASING SHARE OF THE INTERNATIONAL RESPONSE. In 2020, the U.S. disbursed US$6.2 billion, accounting for 76% of total donor government HIV funding (bilateral and multilateral combined). The U.K. was the second largest donor (US$612 million, 7%), followed by Japan (US$258 million, 3%), Germany (US$246 million, 3%), and France (US$216 million, 3%). The U.S. also ranked first when standardized by the size of its economy, followed by the U.K., the Netherlands, and Sweden. Over the past decade, the U.S. share of donor government funding for HIV has grown significantly (the U.S. share was 54% in 2010), as other donor governments have pulled back their support.
- THE OUTLOOK FOR 2021 AND BEYOND IS UNCERTAIN, GIVEN THE ONGOING EFFECTS OF COVID-19. While many donor government economies are starting to rebound from the global economic recession brought on by COVID-19, recovery still remains below pre-pandemic projections, and the environment is fluid.4 This creates significant uncertainty for development aid budgets, including for HIV. Importantly, the increases reported in this year’s report largely reflect prior-year political decisions and the timing of payouts of prior-year funds. As such, they do not yet capture the economic impact of COVID-19 on donor budgeting decisions. In addition, the future impact of COVID-19 in low- and middle-income countries remains tenuous, with some experiencing a “third-wave” and most not expected to gain access to vaccines in any significant way for months if not years. This could lead to even greater funding needs for HIV and other health programs. At the same time, several donor governments have provided emergency COVID-19 support to low- and middle-income countries, some of which may help to address lost ground in the HIV response; this includes, for example, emergency funding provided by the U.S. in 2021 to both PEPFAR and the Global Fund. These factors make it difficult to predict what the ultimate impact will be on funding for HIV in the future.