Financing the Response to HIV in Low- and Middle-Income Countries: International Assistance from Donor Governments in 2015
In advance of the 21st International AIDS Conference (IAC), to be held in Durban, South Africa July 18-22, this report provides the latest data on donor government funding to address the HIV epidemic in low- and middle-income countries. It is part of a more than decade-long partnership between the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Kaiser Family Foundation (Kaiser) to track donor government funding on HIV, assessing both bilateral disbursements and multilateral contributions. The current report provides data for 2015, at the close of the Millennium Development Goals (MDG) era. It finds that funding from donor governments decreased in 2015, by more than US$1 billion, compared to 2014, with declines by 13 of 14 governments assessed. While some of this decrease is due to issues of timing and exchange rate fluctuations, including the significant appreciation of the U.S. dollar, overall spending in 2015 declined even after accounting for these factors. As such, it marks the first decline in donor government funding to address HIV in 5 years.1
Key Findings Include:
- Overall spending for HIV went down in 2015. Donor government spending to address HIV in low and middle-income countries declined by more than $1 billion (US$7.53 billion in 2015 compared to US$8.62 billion in 2014), a 13% decline (see Figure 1). Spending declined for 13 of 14 donor governments assessed in the analysis, and declined even after adjusting for inflation (see Figure 2).2
- The decline is due to a complex set of factors. These include the significant appreciation of the U.S. dollar, resulting in the depreciation of most other donor currencies. However, even in their currencies of origin, funding declined for 11 of 14 governments. Other factors include a delay in disbursements by the U.S. government and the front-loading of pledged contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria by some donors. Still, even after accounting for these factors, funding went down in 2015.
- Bilateral spending declined for all 14 governments. Bilateral spending declined by US$715 million, or 11%, between 2014 and 2015, declining for all 14 governments assessed (and 12 of 14 in currencies of origin). Funding from the U.S. government declined by US$411 million, accounting for 57% of the bilateral spending decline, but this was largely an issue of timing, as the U.S. implements new and expands existing programs and reallocates funding from several over-budgeted countries. Without counting the reduction in U.S. bilateral spending, most of which is expected to be disbursed in 2016, total funding (bilateral and multilateral) from donors declined by 8 percent.
- Multilateral contributions were down for 12 of 14 governments. Contributions to the Global Fund were down by $305 million (after adjusting for an HIV share), declining for 11 of 14 governments assessed (and 8 in currencies of origin). Some of this decline was due to unique factors, including a subset of donors who front-loaded their contributions to the Global Fund in 2014 as part of a three-year, 2014-2016 pledge made during the Global Fund’s last replenishment period, and to the U.S. government’s pledge to match investments in the Global Fund by $1 for every $2 raised, resulting in a decline in 2015. Donor government contributions to UNITAID were also down.
- Most HIV funding is bilateral. In 2015, three quarters of HIV funding (74%) was provided bilaterally, primarily driven by the size of U.S. bilateral disbursements Seven donors provided most of their funding through bilateral channels – Australia, Denmark, Ireland, the Netherlands Norway, the United Kingdom and the United States. Seven donors – Canada, France, Germany, Italy, Japan, Sweden, and the European Commission – provide most of their HIV funding through the Global Fund.
- The U.S. remains the largest donor to HIV. In 2015, the U.S. accounted for two-thirds (66.4%) of donor government disbursements for HIV. The U.K. was the second largest donor (13.0%) followed by France (3.5%), Germany (2.7%), and the Netherlands (2.3%).
- In 2015, several donor governments provided a greater share of funding to HIV than their share of the world’s GDP. This includes the U.S., the U.K., Norway, 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., Norway, and the Netherlands.