Financing the Response to AIDS in Low- and Middle-Income Countries: International Assistance from Donor Governments in 2014
As world leaders meet to discuss the future of financing for development1, this report from the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Kaiser Family Foundation finds that funding to address HIV in low- and middle-income countries from nine of fourteen donor governments assessed either declined or remained flat in 2014; funding from five governments increased. Donor government funding for HIV overall grew by less than 2 percent, totaling US$8.64 billion in 2014. After adjusting for inflation and exchange rate changes, the increase was marginal (1%). Still, this was its highest level to date. Most of the increase in HIV funding in 2014 can be attributed to the United Kingdom, without which overall disbursements would have dropped. In addition, contributions to Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund), an increasing channel of HIV support for some donors over time, went up overall, while bilateral funding went down. Funding from the United States, the largest donor to HIV in the world, was essentially flat.
Key Findings Include:
- In 2014, donor government disbursements for HIV totaled US$8.64 billion (see Figure 1), a less than 2 percent increase (US$149 million) above 2013 levels (US$8.49 billion). While funding had risen sharply in the prior decade, it then stabilized and declined after the global economic crisis. Funding began to rise again recently, with 2014 levels being the highest to date. After adjusting for inflation and exchange rate changes, the increase between 2013 and 2014 was marginal (1%). Increases in funding over the past 10 year period were significantly less in constant dollars than in current dollar spending.
- Most of the overall increase in HIV support in 2014 can be attributed to the U.K., which increased both bilateral support and its contribution to the Global Fund. Without the U.K. increase, disbursements would have declined.
- Contributions to the Global Fund, which undertook significant reforms and finalized a major three year replenishment effort in 2013 to raise resources for the 2014-2016 period, went up overall. Bilateral assistance for HIV declined. While most international assistance for HIV is still provided bilaterally (73% in 2014), the Global Fund has become an increasing channel of support for a subset of donor governments over time. In 2014, six donors provided the majority of their funding for HIV through the Global Fund.
- In addition to the U.K., four of the 14 governments assessed (Italy, Japan, the Netherlands, and Norway) also increased disbursements for HIV in 2014, compared to 2013, although increases by Japan and the Netherlands follow prior declines and are still below earlier funding levels.
- Funding from most other governments (nine of 14) either declined (Australia, Canada, Denmark, France, Ireland, Sweden, and the European Commission) or was essentially flat (Germany and the United States), after accounting for exchange rate fluctuations.
- The U.S. remained the largest donor in 2014 (US$5.6 billion) accounting for approximately two-thirds (64.5%) of donor government disbursements for HIV. The U.K. was the second largest donor (12.9%) followed by France (3.7%), Germany (3.2%), and the Netherlands (2.5%).
- In 2014, several donor governments provided a greater share of funding to HIV than their share of the world’s GDP: the U.S., the U.K., Sweden, and Denmark. However, when standardized by the size of their economies (GDP per US$1 million), Denmark ranks first followed by the U.K., the U.S., Sweden, and the Netherlands.