No increase in AIDS relief funds

Kanaga RAJA

The overall support for global AIDS efforts from donor nations flattened in 2009 in the midst of the global economic crisis, putting a dent on AIDS response.

In 2009, the Group of Eight nations (Canada, France, Germany, Italy, Japan, Russia, the United Kingdom and the United States), the European Commission and other donor governments provided US$7.6 billion for AIDS relief in developing countries, compared to a disbursement of $7.7 billion in 2008, a new analysis of AIDS funding levels has revealed.

According to a joint report by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Kaiser Family Foundation (KFF), the total for 2009 ended a run of annual double-digit percentage point increases in donor support for international AIDS assistance since at least 2002. These results are consistent with preliminary data about overall trends in official development assistance (ODA) during last year's global recession and economic instability.

The joint report was released on the occasion of the XVIII International AIDS Conference in Vienna from 18-23 July.

"Reductions in investment on AIDS programs are hurting the AIDS response. At a time when we are seeing results in HIV prevention and treatment, we must scale up, not scale down," said Michel Sidibe, UNAIDS Executive Director.

In a separate outlook released ahead of the AIDS Conference, UNAIDS outlined a new HIV treatment platform called Treatment 2.0 to simplify the way HIV treatment is currently provided and to scale up access to life-saving medicines.

Treatment 2.0 covers five pillars, namely, create a better pill and diagnostics, treatment as prevention, stop cost being an obstacle, improve uptake of voluntary HIV testing and counseling and linkages to care, and strengthen community mobilization.

According to UNAIDS, compared with current treatment approaches, Treatment 2.0 could avert an additional 10 million deaths by 2025, and could also reduce new HIV infections by up to one million annually, if countries provide antiretroviral therapy to all people in need, following revised treatment guidelines issued by the World Health Organization, which call for earlier initiation of treatment and the use of simpler, better drug regimens.

According to UNAIDS, an estimated five million people living with HIV in low- and middle-income countries are receiving treatment today, up from about 400,000 in 2003 - a more than 12-fold increase in six years.

Despite progress, the global coverage of antiretroviral therapy remains low. For every two people newly on treatment, five more become newly infected. UNAIDS estimates that there were 33.4 million people living with HIV worldwide at the end of 2008. In the same year, there were nearly 2.7 million new HIV infections and two million AIDS-related deaths.

A new UNAIDS study also shows that young people are leading the HIV prevention revolution. HIV prevalence among young people has declined by more than 25% in 15 of the 25 countries most affected by AIDS. These declines are largely due to falling new HIV infections among young people.

For example, in Kenya, there was a 60% decline in HIV prevalence between 2000 and 2005. HIV prevalence dropped from 14.2% to 5.4% in urban areas and from 9.2% to 3.6% in rural areas in the same period. In Ethiopia, there was a 47% reduction in HIV prevalence among pregnant young women in urban areas and a 29% change in rural areas.

According to the joint KFF/UNAIDS report, financing a sufficient and sustained response to the HIV epidemic in low- and middle-income countries has emerged as one of the world's greatest health and development challenges.

International assistance from donor governments, through bilateral aid and contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria and other financing channels such as UNITAID (the international drug purchase facility) is a critical part of this response.

Other funding sources include multilateral institutions, the private sector, and domestic spending by many affected-country governments and the households and individuals within them. Although funding from all these sources has risen significantly over the past decade, the gap between UNAIDS' estimate of resources needed to combat the HIV epidemic and resources available was approximately $7.7 billion in 2009, up from a $6.5 billion gap in 2008.

Moreover, after years of funding increases for AIDS from donor governments, the report finds that funding was essentially flat between 2008 and 2009.

"While this finding generally mirrors the larger trend in overall official development assistance over the same period, and is in part due to exchange rate fluctuations, it also reflects real decreases among some donors, and raises concerns about the ability to fill the AIDS funding gap going forward."

Among the main findings of the joint report are that after years of significant increases for international AIDS assistance provided by the G8, EC, and other donor governments, funding remained essentially flat over the 2008-2009 period.

Disbursements were $7.6 billion in 2009, compared to $7.7 billion in 2008. Identified new commitments (enacted amounts by governments, not all of which are necessarily disbursed in a given year) totaled $8.7 billion, the same as in 2008.

In 2009, the United States was the largest donor in the world, accounting for more than half (58.0%) of disbursements by governments. In fact, without US funding, international AIDS assistance from donor governments would have significantly declined between 2008 and 2009.

According to the report, this year's totals reflect a substantial increase in funding provided by the United States (rising from $3.95 billion in 2008 to $4.4 billion in 2009), which helped to offset reductions in support from Canada, France, Germany, Ireland, Italy, and the Netherlands.

The United Kingdom accounted for the second largest share of disbursements in 2009 (10.2%), followed by Germany (5.2%), the Netherlands (5.0%), and France (4.4%). Denmark accounted for 2.5%.

After adjusting for exchange rate fluctuations, real changes in international AIDS assistance were observed among some donors between 2008 and 2009.

Funding provided by the US, Sweden, and the European Commission increased in real terms, while funding from Canada, France, Germany, Ireland, Italy, and the Netherlands decreased. Funding provided by Australia, Japan, and Norway was essentially flat. - Third World Network Features