‘A mixed story’ for HIV funding in 2013

With more than 14,000 delegates registered, including the six AIDS researchers and activists who were among those killed when a plane was shot down last week over eastern Ukraine, the 20th International AIDS Conference kicked off yesterday in Melbourne, Australia. The conference aims not just to review the gains made in the global fight against HIV and AIDS, but also to mobilize additional funding for the cause. While support for HIV and AIDS interventions over the years has been significant, a lot still needs to be done to reverse the spread of the disease. Global funding commitments to HIV and AIDS in 2013 fell 3 percent year on year to $8.07 billion, mainly as a result of decreasing commitments from the United States, a recent report from the Kaiser Family Foundation and UNAIDS noted. But because the donor country accelerated its payout of 2012 commitments, total disbursements increased 8 percent to $8.46 billion. Disbursements in 2013 would have remained flat without this acceleration. Accounting for around two-thirds of global disbursements for HIV, the United States represents what the report calls an “anomaly” in its assessment of donor governments’ HIV response. While the United States has long been the largest donor to HIV and AIDS programs, its bilateral commitments have fallen since peaking in 2010. The proposed budget for fiscal year 2015, according to the report, also shows a funding level that is below fiscal 2008 levels. U.S. contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria increased every year from 2010 to 2013. But the report noted that while the 2014 contribution level matches that of 2013, the 2015 contribution will decrease by $300 million due to legislative requirements that the U.S. channel no more than 33 percent of total contributions to the Global Fund. While only a few countries directed a large portion of their HIV funding toward multilateral channels such as the Global Fund and UNITAID, the report notes several donors seem to be funneling an increasing share of their HIV aid to the Global Fund — a trend that, given the nature of the Global Fund, which provides funding for three diseases, could result in a lower share of funding for HIV and AIDS programs in the long term. According to UNAIDS estimates, global HIV funding from all sources — donor government bilateral assistance, multilateral institutions, domestic public and private spending, and private philanthropic aid — amounted to $19.14 billion in 2013. While substantial, it still falls short of the $22 billion to $24 billion target set by the United Nations for 2015. When ranked by disbursements, the top five donor governments to the HIV and AIDS response in 2013 are the United States, the United Kingdom, France, Germany and Denmark. But when government disbursements are ranked by the standardized size of their economies — that is, funding for HIV per $1 million in gross domestic product — then Denmark ranks first, followed by the United States, the United Kingdom, Sweden and Ireland. Below, we take a closer look at these donor governments’ recent and future efforts. Denmark HIV and AIDS assistance has been one of the main priorities of the Danish International Development Agency since 2001. Recognizing that HIV and AIDS must not only be treated as a health issue, DANIDA mainstreams its response by incorporating sexual and reproductive health into its programs. Denmark devotes a large share of its resources to HIV programs, but it is expected to change the way it delivers some of its assistance. Last year, Tanzania Commission for AIDS Executive Chairperson Fatma Mrisho announced that Denmark, along with Canada, would no longer contribute to Tanzania’s National Multisectoral Strategic Framework for HIV and AIDS, starting in 2015. The withdrawal came after the World Health Organization revised its guidelines on the provision of antiretroviral therapy. In light of the planned reduction of donor support, Tanzania, which has been one of Denmark’s longtime priority areas for its HIV and AIDS programming, is planning to establish an AIDS Trust Fund. France Fifteen percent of the French Development Agency’s funding for NGOs went to health and HIV prevention efforts in 2013. A larger chunk of France’s HIV assistance, however, goes to multilateral institutions. France had the third-highest pledged amount — $1.5 billion for the period 2014-16 — at the fourth Global Fund replenishment held in Washington, D.C., last December. France is also the largest donor to UNITAID, which former U.S. President Bill Clinton has called “France’s gift to the world.” France’s successful implementation of its air ticket levy — the collected tax goes to UNITAID and serves as the U.N. body’s main financing mechanism — has paved the way for the Financial Transaction Tax. Last September, French President François Hollande announced a 12.7 percent increase on the tax, resulting in a rise of the levy paid on economy domestic flights by 13 euro cents ($0.18) and on economy international flights by 51 euro cents. Germany The German Agency for International Cooperation’s health programs are focused on HIV and AIDS and sexual and reproductive health rights. But like France, Germany has a greater share of multilateral disbursements. In 2013, it channeled more than half of its HIV and AIDS assistance through the Global Fund. It also promised $815.4 million at the recent Global Fund replenishment. Germany is also only one of two countries that are part of the Debt2Health mechanism, which requires beneficiary governments to invest a set amount in a Global Fund-approved health program. Through the initiative, Germany has written off certain amounts of debt from Indonesia, Pakistan and Ivory Coast. Ireland Health, including support for efforts to prevent and treat HIV and AIDS, made up 22 percent of Ireland’s bilateral aid in 2013, making this sector the highest priority of Irish aid spending last year. Lesotho, Mozambique, South Africa, Tanzania and Zimbabwe were the main recipients of Ireland’s HIV assistance. Irish Aid, the Irish government’s program for overseas development, mainly works with nongovernmental organizations in its partner countries. A partnership with the Clinton Foundation Health Access Initiative, meanwhile, has allowed it to scale up funding for HIV programs in Lesotho and Mozambique. Aside from HIV interventions, Irish assistance targets eliminating the stigma associated with HIV and AIDS and advocating the needs of women and children. Sweden Representing a fifth of Sweden’s health aid in 2013, Swedish spending on the HIV and AIDS response has largely been focused on eastern and southern Africa. Although UNAIDS recorded a significant drop in new HIV infections in the two regions from 2001 to 2011, HIV prevalence rates remain high. The Swedish International Development Cooperation Agency’s support has mostly been channeled toward HIV and AIDS programs of regional organizations and U.N. agencies. Private sector partnership, however, is likely to move up SIDA’s priorities in the next few years. Bilateral disbursements still make up the bulk of Swedish HIV aid. But Sweden’s $380.8 million pledge to the Global Fund for 2014-16 — an almost 27 percent increase from the $300 million it promised for 2011-13 — could signal more HIV funding being funneled through multilateral institutions. United Kingdom The U.K. Department for International Development focuses its HIV and AIDS prevention and treatment efforts on sub-Saharan Africa. In a position paper published last November, DfID reiterated three strategic priorities for its HIV and AIDS assistance: to significantly reduce new infections; to scale up access to diagnosis, treatment, care and support; and to significantly reduce stigma and discrimination. From 2012-13, DfID developed four new HIV prevention programs, which are supposed to reduce new HIV infections in the region by at least 500,000 women by 2015. While the United Kingdom still directs a bulk of its HIV aid bilaterally, the country, like France, is one of the major funders of UNITAID. Meanwhile, at the recent Global Fund replenishment, it promised $1.6 billion for 2014-16, making it the country with the second-highest pledged amount. United States In 2013, the U.S. President’s Emergency Plan for AIDS Relief, an initiative launched by former President George W. Bush and continued and strengthened by President Barack Obama, marked its 10th year. Through PEPFAR, the United States has addressed what was “truly a death sentence in Africa.” In 2013 alone, it supported 6.7 million men, women and children on antiretroviral treatment through bilateral programs — a figure that exceeds the 6 million goal set by President Obama for 2013 on World AIDS Day 2011. The United States promised more than $4 billion for 2014-16 at the Global Fund’s last replenishment meeting in December — the highest pledge among donor governments. The country has been funding HIV and AIDS programs since 1986, and has historically been the top bilateral donor to HIV interventions. But while U.S. spending in HIV rose significantly in the previous decade, the report notes that funding is likely to decrease in coming years. Check out more insights and analysis provided to hundreds of Executive Members worldwide, and subscribe to the Development Insider to receive the latest news, trends and policies that influence your organization.