Donor Government Funding for HIV in Low- and Middle-Income Countries in 2022

Key Findings

This report provides an analysis of donor government funding to address the HIV response in low- and middle-income countries in 2022, 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. Overall, the analysis shows that while donor government funding for HIV increased between 2021 and 2022, this was primarily due to the timing of payments from the U.S. government and not actual increases in commitments. More broadly, UNAIDS reports that total global resources for HIV – including domestic funding – declined slightly in 2022 and are well below the estimated US$29.3 billion needed by 2025 to reach global goals; donor governments account for more than a third of total HIV resources. In addition, while there has been significant progress in addressing the HIV epidemic, new infections and AIDS-related deaths are on the rise in some regions and more than 9 million people living with HIV still lack access to antiretroviral therapy.¹ With continued pressures on domestic and international resources resulting from the war in Ukraine, economic stress, and other challenges, future support for HIV remains uncertain. Key findings include the following:

• Donor government funding for HIV increased in 2022 compared to the prior year. Disbursements were US$8.2 billion in 2022, an increase of more than US$700 million compared to 2021 (US$7.5 billion), in current U.S. dollars (funding increased even after accounting for inflation and exchange rate fluctuations).² This increase essentially returns funding to 2020 levels in nominal terms, after a decline last year. More broadly, the real value of funding has fallen over the past decade due to the effects of inflation.
• However, the increase in 2022 was primarily due to the timing of U.S. disbursements, rather than increased commitments. U.S. funding totaled US$6.1 billion in 2022, almost US$600 million above 2021 (US$5.5 billion), and included increases in both bilateral disbursements as well as contributions to the Global Fund.³ These increases, however, were entirely due to the timing of disbursements of prior-year funding rather than increased commitments, as the funding amounts specified by the U.S. Congress for both bilateral HIV programs and the Global Fund have been relatively flat through 2022.⁴ Similarly, while funding from all other donor governments also increased in 2022, this was largely attributable to the timing of Global Fund contributions from France and the European Commission.
• The U.S. continues to be the largest donor to HIV, even after adjusting for the size of its economy. In 2022, the U.S. disbursed US$6.1 billion, accounting for 74% of total donor government HIV funding (bilateral and multilateral combined).⁵ France was the second largest donor (US$382 million, 5%), followed by the U.K. (US$376 million, 5%), the European Commission (US$328 million, 4%), and Germany (US$191 million, 2%). The U.S. also ranked first when standardized by the size of its economy, followed by the Netherlands, France, Sweden, and Denmark.
• Looking at the longer-term trend, funding is below historical levels, largely due to declines in bilateral funding from donor governments other than the U.S. Total bilateral funding from other donor governments has decreased each year for more than a decade (by almost US$1.4 billion or 80% since 2011). While increases in multilateral funding have offset these declines in some years, overall funding is still more than US$1.0 billion below where it was just over a decade ago. This also suggests that the already significant dependency of international HIV resources on the U.S. could grow.
• Taken together, this means that the donor government funding pie, which accounts for more than a third of all global HIV resources, is not growing. Rather, funding has fluctuated for several years, with year-to-year changes largely due to the normal ebb and flow of payment timing and Global Fund pledging periods, but not increasing government commitments to HIV; in fact, current levels are below the high-water mark reached almost a decade ago (US$8.6 billion in 2014). As donor governments continue to face budgetary pressures ranging from ongoing inflation as well the economic impacts associated with the war in Ukraine, increased funding for HIV moving forward is uncertain.⁶ While donor pledges for the Global Fund’s 2023-2025 replenishment period reached their highest level to date, indicating that increased resources may be available in the future, this will be dependent on donor fulfillment of their pledges amid these ongoing constraints.⁷ More broadly, UNAIDS reports that funding for the global HIV response from all sources declined in the last year, driven by decreased funding from domestic governments who are facing significant economic pressures, making the gap between available resources and projected need even greater.⁸