Global AIDS Spending Up Nine-Fold Since 1996; Funding Still Falls Short of Projected Need, UNAIDS Report Says
Governments, international organizations, foundations and nongovernmental organizations in 2003 will spend an estimated $4.7 billion to address the AIDS epidemic in low- and middle-income countries, but that amount is less than half of the more than $10.5 billion that will be needed each year by 2005 to fight the epidemic in those countries, according to a UNAIDS report released yesterday, Reuters reports (Reuters, 6/26). The "Report on the State of HIV/AIDS Financing" shows that global spending on HIV/AIDS increased nine-fold from 1996 to 2002, from just under $300 million to more than $2.8 billion. The $4.7 billion estimate includes $1.6 billion in international bilateral assistance; $1 billion in spending through multilateral programs and the Global Fund to Fight AIDS, Tuberculosis and Malaria; $1 billion in projected spending by governments in affected countries; and more than $1 billion in spending by individuals/households in affected countries (UNAIDS release, 6/26).
"Even with recent increases in AIDS spending, the mismatch between need and funding continues to be one of the biggest obstacles in the struggle to control the epidemic," UNAIDS Executive Director Peter Piot said, adding, "Although we are halfway there in closing the AIDS funding gap, there is still halfway to go" (Fowler, Associated Press, 6/26). According to the report, more than $10.5 billion will be needed each year by 2005 to provide a "bare bones" package of prevention, treatment, care and support programs in low- and middle-income nations. By 2007, almost $15 billion will be needed to provide such services, the report said (Williams, Financial Times, 6/27). That spending level will have to be maintained for at least 10 years, according to UNAIDS (UNAIDS fact sheet, June 2003). In order to meet the projected $10.5 billion need by 2005, funding from all sources will have to more than double from their 2003 levels, according to a UNAIDS statement (Reuters, 6/26).
U.S., European Funding
The United States and European nations have recently announced their intentions of increasing their international AIDS funding through bilateral and multilateral channels, including the Global Fund (UNAIDS release, 6/26). Last month, President Bush signed into law a global AIDS bill (HR 1298) that authorizes $3 billion a year for five years to HIV/AIDS programs in Africa and the Caribbean, with up to $1 billion in fiscal year 2004 going to the Global Fund. However, the amount of funding actually appropriated to the fund may be less than $1 billion, as it is contingent upon congressional budget action and the contributions of other countries. European Union leaders on June 20 at a summit in Greece were unable to agree on pledging about $1 billion to the Global Fund that would have matched the U.S. pledge. The nations are expected to decide on a final amount at the upcoming Global Fund supporters' meeting scheduled for July 16 in Paris, (Kaiser Daily HIV/AIDS Report, 6/23). Even if these pledges are fully realized, the funding would amount to additional annual spending of $1.2 billion by 2005, leaving a gap that is still about $5 billion, according to UNAIDS. "It is important that announced funding increases for 2004 are converted into funds that reach prevention and care programs on the ground," Piot said, adding, "But it is even more important that spending keeps on increasing through 2005, and beyond" (Reuters, 6/26).
Funding Mechanisms, Factors
In addition to the need for increased donor support through bilateral assistance programs, UNAIDS also outlined several mechanisms and factors that are important to bridging the gap in AIDS funding in the coming years.
- The Global Fund, which is a public-private partnership that has been operating since 2002, has received $4.6 billion in total pledges as of this month, with the majority of pledges coming from donor countries' government budgets and the endowments of major foundations (UNAIDS fact sheet, June 2003). In its first two rounds of grant awards, the fund approved $1.5 billion to go to more than 150 programs in 93 countries. A third round of approvals, based on the availability of funds and the review of more than 200 proposals from 85 countries, is scheduled for October (Global Fund fact sheet, June 2003).
- The Multi-Country HIV/AIDS Program for Africa, which is managed by the World Bank, consists of zero-interest loans and grants for eligible countries to support government efforts to fight HIV/AIDS. The initial stage of $500 million was approved in September 2001 and supported 13 countries in sub-Saharan Africa. The World Bank allocated another $500 million in February 2002 in order to support an additional 12 to 15 countries. A similar initiative, totaling $155 million, is under way in the Caribbean. The Multi-Country HIV/AIDS Prevention and Control Project for the Caribbean is a five-year loan program meant to support national HIV/AIDS control programs.
- Debt relief for low-income countries can also help to boost responses to the AIDS epidemic, according to UNAIDS. On average, the debts of the 38 highly indebted poor countries amount to more than four times their annual export earnings on average, undermining social spending, including spending on HIV/AIDS programs and orphan resources. The HIPC debt initiative, started by the World Bank and the International Monetary Fund, attempts to alleviate the stresses caused by debt burdens. Eligible countries can qualify for debt relief if they meet certain criteria, including adopting strategies in which social spending is a priority.
- The business sector also plays an important role in the fight against AIDS, as approximately 7% of the total spending need is for workplace prevention programs, which private companies can fund, according to UNAIDS (UNAIDS fact sheet, June 2003).