Financing the response to HIV in low-income and middle-income countries

AIDS Financing and Economics Division, Joint United Nations Program on AIDS (UNAIDS), Geneva, Switzerland.
JAIDS Journal of Acquired Immune Deficiency Syndromes (Impact Factor: 4.39). 12/2009; 52 Suppl 2(Suppl 2):S119-26. DOI: 10.1097/QAI.0b013e3181baeeda
Source: PubMed

ABSTRACT To describe levels of national HIV spending and examine programmatic allocations according to the type of epidemic and country income.
Cross-sectional analysis of HIV expenditures from 50 low-income and middle-income countries. Sources of information included country reports of domestic spending by programmatic activity and HIV services. These HIV spending categories were cross tabulated by source of financing, stratified by type of HIV epidemic and income level of the country and reported in international dollars (I$).
Fifty low-income and middle-income countries spent US $ 2.6 billion (I$ 5.8 billion) on HIV in 2006; 87% of the funding among the 17 low-income countries came from international donors. Average per capita spending was I$ 2.1 and positively correlated with Gross National Income. Per capita spending was I$ 1.5 in 9 countries with low-level HIV epidemics, I$ 1.6 in 27 countries with concentrated HIV epidemics and I$ 9.5 in 14 countries with generalized HIV epidemics. On average, spending on care and treatment represented 50% of AIDS spending across all countries. The treatment-to-prevention spending ratio was 1.5:1, 3:1, and 2:1 in countries with low-level, concentrated and generalized epidemics, respectively. Spending on prevention represented 21% of total AIDS spending. However, expenditures addressing most-at-risk populations represented less than 1% in countries with generalized epidemics and 7% in those with low-level or concentrated epidemics.
The most striking finding is the mismatch between the types of HIV epidemics and the allocation of resources. The current global economic recession will force countries to rethink national strategies, especially in low-income countries with high aid dependency. Mapping HIV expenditures provides crucial guidance for reallocation of resources and supports evidence-based decisions. Now more than ever, countries need to know and act on their epidemics and give priority to the most effective programmatic services.

Download full-text


Available from: Carlos Avila, Aug 15, 2015
1 Follower
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Donors, developing country governments, and NGOs are searching for ways to use funding for HIV/AIDS programs that strengthen the functioning of weak health systems. This is motivated both by the realization that a large share of donor funding for global health is and will continue to be dedicated to HIV/AIDS, and that the aims of more and better treatment, prevention, and care can be achieved only with attention to systemic capacities. For AIDS resources to strengthen health systems, decision makers should: (a) mitigate the risks that AIDS spending may weaken the ability of health systems to respond to other health problems; (b) find ways for procurement, supply chain, management information, and other systems that are created to support AIDS treatment to be broadened to serve other types of services; and (c) build upon the ways in which AIDS programs have overcome some demand-side barriers to use of services. In pursuing this agenda, donors should recognize that health system development is a function of the national and local political economy and place respect for national sovereignty as a central tenet of their policies and practices.
    JAIDS Journal of Acquired Immune Deficiency Syndromes 11/2009; 52 Suppl 1:S3-5. DOI:10.1097/QAI.0b013e3181bbc807 · 4.39 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: HIV has devastated numerous countries in sub-Saharan Africa and is a dominant health force in many other parts of the world. Its undeniable importance is reflected in the establishment of Millennium Development Goal No. 6. Unprecedented amounts of funding have been committed and disbursed over the past two decades. Many have argued that this enormous influx of funding has been detrimental to building stronger health systems in recipient countries. This paper examines the funding share for HIV measured against the total funding for health. A descriptive analysis of HIV and health expenditures in 2007 from 65 countries was conducted. Comparable data from individual countries was used by applying a consistent definition for HIV expenditures and total health expenditures from NHAs to align them with National AIDS Assessment Reports. In 2007, the total public and international expenditure in LMICs for HIV was 1.6 percent of the total spending on health, while the share in SSA was 19.4 percent. HIV prevalence was six-fold higher in SSA than the next highest region and it is the only region whose share of HIV spending exceeded the burden of HIV DALYs. The share of HIV spending across the 65 countries was quite moderate considering that the estimated share of deaths attributable to HIV stood at 3.8 percent and DALYs at 4.4 percent. Several high spending countries are using a large share of their total health spending for HIV health, but these countries are the exception rather than representative of the average SSA country. There is wide variation between regions, but the burden of disease also varies significantly. The percentage of HIV spending is a useful indicator for better understanding health care resources and their allocation patterns.
    PLoS ONE 09/2010; 5(9):e12997. DOI:10.1371/journal.pone.0012997 · 3.53 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: As the global HIV/AIDS pandemic nears the end of its third decade, the challenges of efficient mobilisation of funds and management of resources are increasingly prominent. The aids2031 project modelled long-term funding needs for HIV/AIDS in developing countries with a range of scenarios and substantial variation in costs: ranging from US$397 to $722 billion globally between 2009 and 2031, depending on policy choices adopted by governments and donors. We examine what these figures mean for individual developing countries, and estimate the proportion of HIV/AIDS funding that they and donors will provide. Scenarios for expanded HIV/AIDS prevention, treatment, and mitigation were analysed for 15 representative countries. We suggest that countries will move in increasingly divergent directions over the next 20 years; middle-income countries with a low burden of HIV/AIDS will gradually be able to take on the modest costs of their HIV/AIDS response, whereas low-income countries with a high burden of disease will remain reliant upon external support for their rapidly expanding costs. A small but important group of middle-income countries with a high prevalence of HIV/AIDS (eg, South Africa) form a third category, in which rapid scale-up in the short term, matched by outside funds, could be phased down within 10 years assuming strategic investments are made for prevention and efficiency gains are made in treatment.
    The Lancet 10/2010; 376(9748):1254-60. DOI:10.1016/S0140-6736(10)61255-X · 45.22 Impact Factor
Show more