Donor Government Funding for HIV in Low- and Middle-Income Countries in 2024

In 2025, the donor government funding landscape fundamentally changed. Under the new administration, the United States, the largest donor to HIV in the world, has instituted significant changes to global health programs including freezing, and then cancelling, most global HIV projects, restricting allowable activities, and seeking to cut HIV funding by at least 40%, actions which have collectively driven down disbursements. In addition, several other large donors to HIV – the United Kingdom, Germany and France – have also signaled reductions in their development assistance budgets. As such, this report, which focuses on both bilateral and multilateral funding for HIV provided by donor governments in 2024 and shows an increase over 2023, is likely the high watermark as funding will likely decline moving forward. While the U.S. has shouldered much of the burden of funding the HIV response, its abrupt reductions leave large gaps and could set back the HIV response, as some studies have already found. Key findings are as follows:

• Donor government funding for HIV increased in 2024 compared to the prior year. Disbursements for combined bilateral and multilateral support were US$8.37 billion in 2024, an increase of US$460 million compared to 2023 (US$7.91 billion), in current U.S. dollars (not adjusted for inflation).¹ Funding increased even after accounting for exchange rate fluctuations. Looking more broadly, donor government funding for HIV in 2024 was at its highest level since 2014 (US$8.60 billion), but still below that peak.
• The increase in 2024 was almost entirely due to the timing of disbursements by the U.S., not actual changes in funding commitments. The timing of disbursements, or payouts, by donor governments fluctuates each year and those fluctuations can affect overall levels of funding availability, independent of donor funding commitments. In 2024, the U.S. government’s disbursements for HIV increased significantly, while the U.K.’s payout declined, but both were due to the timing of payouts. Other donors had similar fluctuations. Because the U.S. is the largest donor, its fluctuations drove up overall funding levels in 2024.
• Bilateral funding increased in 2024, driven by payout timing. Bilateral funding totaled US$5.87 billion in 2024, an increase of US$241 million compared to 2023 (US$5.63 billion), with five donors providing increased disbursements. The increase was primarily the result of higher funding from the U.S., due to the timing of payouts, and the U.K., as well as slight increases from Australia, Japan, and Norway. Funding from eight donor governments decreased and two remained flat.
• Multilateral funding, which is the main channel of support for HIV used by most donor governments, also increased in 2024, similarly due to the timing of contributions. Multilateral funding totaled US$2.50 billion in 2024, an increase of US$218 million compared to 2023 (US$2.28 billion). Six donor governments increased multilateral support, while four remained flat, and five declined. Most multilateral funding for HIV was provided to the Global Fund (US$2.27 billion or 91%) with smaller amounts provided to UNAIDS (US$169 million or 7%) and UNITAID (US$59 million or 2%). The timing of payments to the Global Fund drove the multilateral increase in 2024.
• The U.S. has consistently been the largest donor to HIV. In 2024, the U.S. provided US$6.69 billion for HIV (bilateral and multilateral combined), accounting for 80% of total donor government support.² France was the second largest donor (US$314 million, 4%), followed by Germany (US$226 million, 3%), the U.K. (US$218 million, 3%), and the Netherlands (US$192 million, 2%).^3,4 Even when standardized by the size of its economy (per million GDP), the U.S. ranked first. The next largest donor, per million GDP, was the Netherlands, followed by Denmark, France, and Norway.

Looking ahead, donor government funding for HIV is expected to decline in 2025 and beyond. Due to the new administration’s actions targeting U.S. foreign assistance programs, including for global health and HIV, U.S. disbursements for HIV this year are well below prior year levels.⁵ In addition, the administration has asked Congress to rescind (formerly cancel) approximately US$400 million in bilateral HIV funding for 2025 and has proposed reducing the HIV budget by at least 40% in 2026. If these cuts were to materialize, other donor governments would have to more than double their HIV funding to maintain current levels. Given that the U.S. has already reduced HIV spending in 2025 and several other large donors have announced plans to reduce foreign assistance, funding for HIV in low- and middle-income countries is highly likely to decline.