Introduction
Financing the response to the global HIV/AIDS epidemic has emerged as one of the world's greatest challenges, and one that will be with us for the foreseeable future. Often, those countries most affected are also least resourced, increasing their vulnerability to HIV/AIDS and complicating their ability to respond, as is the case for many nations in sub-Saharan Africa. In addition, there is concern about a potential "next wave" of the epidemic in several of the world's most populous nations, particularly China, India, and Russia, which stand on the brink of generalized epidemics if more is not done now. Yet analyses indicate that if effective HIV prevention programs, coupled with treatment, were truly brought to global scale, and on a sustained basis, millions of future infections could be prevented and HIV-related mortality reduced.1,2,3 Given the magnitude of the epidemic, the role of international donor assistance in low and middle income countries has been and continues to be critical.
Indeed, funding from international donors has risen significantly over the past several years, owing primarily to donor government assistance through bilateral aid and contributions to The Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund ).4,5 The World Bank also provides substantial funding for HIV/AIDS,6 as does the private sector (foundations, corporations, international nongovernmental organizations, and individuals). Notably, many affected country governments allocate domestic resources to combat their epidemics, and households and individuals within these countries often shoulder at least some, if not much, of the financial burden. Taken together, it is estimated that resources made available from all of these funding streams rose from approximately $300 million in 1996 to $6.1 billion in 2004, and are expected to reach $8 billion in 2005.7,8,9
Despite increases in funding for HIV/AIDS, however, official estimates suggest that a considerable financing gap remains, one that will likely grow over time. 7,8,10 The Joint United Nations Programme on HIV/AIDS (UNAIDS) now estimates that $15 billion will be needed to effectively respond to the HIV/AIDS epidemic in low and middle income countries in 2006, rising to $22 billion in 2008. Ultimately, most of these resources will need to come from the international community.7,11,12
Within the international community, donor governments have an especially vital role to play in filling this gap. This is particularly true of the Group of 7 (G7) - Canada, France, Germany, Italy, Japan, the United Kingdom, and the United States - and the European Commission (EC), some of the wealthiest donors in the world and major contributors of foreign development assistance. For example, in 2004, the G7 accounted for an estimated 72%13 of total net official development assistance (ODA) provided by the Development Assistance Committee (DAC) of the Organisation for Economic Co-operation and Development (OECD).14,15
This paper provides the latest available data on funding for HIV/AIDS in low and middle income countries by the G7 and the EC, including their bilateral aid and contributions to the Global Fund. Data are provided for 2004 (some of which are preliminary only). Included are both estimated funding commitments and disbursements As past studies have found, further corroborated by the current analysis, funding from the G7 and EC for HIV/AIDS represents a relatively complete picture of donor government efforts overall (87%) and therefore serves as an important gauge of international assistance for HIV/AIDS.16 Such data also serve to inform multiple other efforts including:
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Resource mobilization;
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Monitoring of progress towards international development targets (e.g., Millennium Development Goals, United Nations General Assembly on HIV/AIDS, Monterrey Consensus, and others);
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Assessing additionality (that is, that net assistance for HIV/AIDS represents an increase over existing efforts for HIV/AIDS and development assistance more generally);
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Understanding "fair share" (the contributions of donors relative to their wealth and other factors);
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Facilitating transparency; and
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Providing a critical link in the larger HIVAIDS foreign aid equation of: where is assistance going, how quickly, for what, and to what effect.
Footnotes:
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Stover, J., et.al., "Can We Reverse the HIV/AIDS Pandemic with an Expanded Response?", The Lancet, Vol. 360, July 6, 2002.
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Salomon, J. et.al., Integrating HIV Prevention and Treatment: From Slogans to Impact, PLOS Medicine, Vol. 2, No. 1, January 2005.
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UNAIDS, Policy Position Paper: Intensifying HIV Prevention, UNAIDS/PCB(17)/05.3, June 27-29, 2005.
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UNAIDS, 2004 Report on the Global AIDS Epidemic, July 2004.
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UNAIDS, Global Resource Tracking Consortium for AIDS, Financing the Response to AIDS, Prepublication Draft, July 2004.
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World Bank, "World Bank Intensifies Action Against HIV/AIDS", June 2004 (http://web.worldbank.org/).
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UNAIDS, Discussion paper for round table on resources to be convened by the Joint United Nations Programme on HIV/AIDS, the World Bank and the Global Fund to fight AIDS, Tuberculosis and Malaria, High Level Meeting on HIV/AIDS, March 24, 2005.
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UNAIDS, Press Release: AIDS Epidemic Still Outpacing Response, June 2, 2005.
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Opuni, M. and Bertozi, S., Financing HIV/AIDS Prevention and Care in Low- and Middle-Income Countries, September 2003 (available at: http://hivinsite.ucsf.edu/InSite?paqe=pa-rr-03).
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UNAIDS, Resource Needs for an Expanded Response to AIDS in Low and Middle Income Countries, PCB 17 Conference Paper, June 27-29, 2005.
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Schwartlander B., et.al., "Resource Needs for HIV/AIDS," Science, Vol. 292, No. 5526, June 2001.
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UNAIDS, Fact Sheet: Funding for AIDS July 2004.
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This figure includes aid provided to the European Union (EU) by the four G7 members who are also part of the EU (France, Germany, Italy and the United Kingdom).
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Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Japan, Luxembourg, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, United Kingdom, United States, European Commission.
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OECD, April 11, 2005 (http://www.oecd.org/dataoecd/59/51/34700392.pdf).
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UNAIDS/Kaiser Family Foundation Analysis, June 2005.
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