Donor Government Funding for HIV in Low- and Middle-Income Countries in 2021
This report provides an analysis of donor government funding to address HIV in low- and middle-income countries in 2021, 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. Donor government funding for HIV declined between 2020 and 2021, primarily due to the timing of payments rather than decrease in support in the past year. Still, this means that funding was largely flat in 2021 compared to the prior year, even as 1.5 million people were newly infected with HIV, 650,000 died from AIDS, and global progress is slowing and well below targets.1 This also occurred amid the ongoing impacts of COVID-19 and the war in Ukraine, and against a backdrop of growing inflation as well as shrinking HIV support from other sources.2 Moreover, donor support is not keeping pace with inflation, as funding in 2021 essentially matched 2008 levels in nominal terms, and several donors have reduced their support for HIV over the past decade. As such, there is significant uncertainty about the future, as the COVID pandemic continues to effect economies around the world and donors face other global pressures. Key findings include the following:
- DONOR GOVERNMENT FUNDING FOR HIV DECLINED IN 2021 COMPARED TO THE PRIOR YEAR. Disbursements were US$7.5 billion in 2021, a decrease of US$670 million below 2020 (US$8.2 billion), in current U.S. dollars (funding declined even after accounting for inflation and exchange rate fluctuations).3 Still, looking more broadly, funding in 2021 is approximately at the same level as 2008, in nominal terms, and has fallen over that period after accounting for inflation.
- THE DECLINE BETWEEN 2020 AND 2021 WAS PRIMARILY DUE TO THE TIMING OF PAYMENTS RATHER THAN A DECREASE IS SUPPORT IN THE PAST YEAR. Contributions to the Global Fund were US$1.8 billion in 2021 (after adjusting for an HIV-share), compared to US$2.3 billion in 2020, a decline of approximately $500 million, with disbursements decreasing from the U.S., Japan, and the U.K. However, these declines were part of regular fluctuations in three-year pledged contributions over the 2020-2022 period and do not reflect actual reductions in funding commitments. For instance, Japan and the U.K., provided a large share of their pledge at the beginning of the pledge period and the U.S. provided a large disbursement last year; all are on track to fulfill their funding commitments.4,5
- HOWEVER, THERE WAS SOME DECLINE IN BILATERAL FUNDING, CONTINUING A LONGER-TERM TREND IN DECLINING BILATERAL SUPPORT FROM DONOR GOVERNMENTS OTHER THAN THE U.S., WHICH BEGAN OVER A DECADE AGO. Bilateral funding in 2021 was US$5.5 billion compared to US$5.6 billion in 2020, a decline of approximately $100 million. Most of this was due to reduced funding from the U.K. and was not unexpected due to the U.K. government’s decision to reduce overall official development assistance (ODA).6 More broadly, since 2011, bilateral funding from donor governments other than the U.S. has declined by almost US$1.3 billion, reductions not fully compensated for by increases in multilateral support.
- THE U.S. IS THE LARGEST DONOR TO HIV, EVEN AFTER ADJUSTING FOR THE SIZE OF ITS ECONOMY, AND ACCOUNTS FOR A GROWING SHARE OF BILATERAL SUPPORT. In 2021, the U.S. disbursed US$5.5 billion, accounting for 73% of total donor government HIV funding (bilateral and multilateral combined). The U.K. was the second largest donor (US$385 million, 5%), followed by Germany (US$246 million, 3%), the European Commission (US$232 million, 3%), and France (US$231 million, 3%). The U.S. also ranked first when standardized by the size of its economy, followed by the Netherlands, Sweden, and the U.K. Largely due to declines by all other donors, the U.S. now accounts for 92% of bilateral support whereas it accounted for 70% a decade ago.
- THE OUTLOOK FOR 2022 AND BEYOND IS UNCERTAIN, GIVEN THE ONGOING EFFECTS OF COVID-19, THE WAR IN UKRAINE, AND OTHER GLOBAL PRESSURES ON DONOR GOVERNMENT BUDGETS. While donor government funding for HIV in low and middle income countries does not seem to have been negatively impacted by COVID-19 thus far, support has stayed flat and has not kept pace with inflation, and some donors have reduced their support for HIV over the past decade.7 In addition, the economic and health effects of the COVID-19 pandemic are still being felt around the world, and there remains significant uncertainty about the future course of COVID itself.8 More generally, several donors have announced plans to cut ODA funding in order to support in-country costs associated with refugees from the war in Ukraine, and inflationary pressures are threatening budgets further.9 One of the biggest markers ahead for future HIV funding will be the Global Fund’s 7th replenishment conference this fall10, which will be hosted by the U.S. government, the outcome of which will likely set the stage for donor support for years to come.