UN report predicts shortfall in AIDS funding in developing countriesBMJ 2003; 327 doi: http://dx.doi.org/10.1136/bmj.327.7405.10-b (Published 03 July 2003) Cite this as: BMJ 2003;327:10
Funding for the prevention and treatment of AIDS in low and middle income countries is only about half what is needed to provide basic services, warned a report published by the Joint United Nations Programme on HIV/AIDS (UNAIDS) last week.
The Report on the State of HIV/AIDS Financing estimated that $4.7bn (£2.8bn; €4.1bn) should be available to spend on the AIDS epidemic in developing countries in 2003. This figure was based on pledges from private, national, and international funding sources. Although funding has increased considerably over the past five years, it is likely to fall far short of that needed in the future. The report estimated that more than $10.5bn a year would be needed by 2005 for a “barebones” package of prevention, treatment, care, and support programmes.
The United States, the European Commission, and European national governments recently announced increased AIDS funding, including new pledges to the Global Fund to Fight AIDS, Tuberculosis, and Malaria. This would provide an additional $1.2bn annually by 2005, but this would still leave a gap of nearly $5bn. By 2007, almost $15bn would be needed, the report predicted, adding that this level of funding “would need to be maintained for at least a decade to successfully combat AIDS.” The analysis showed that almost two thirds of the funding comes from 12 national governments and other bodies.
“The longer the world fails to meet its AIDS funding targets, the more lives will be lost,” said Dr Peter Piot, executive director of UNAIDS. “Every year that we delay reaching the spending target means another five million new infections. And every person with AIDS who is not reached under our target for extending antiretroviral treatment is likely to die within two years.”
Dr Paul de Lay, director of monitoring and evaluation at UNAIDS, added that the likely shortfall in AIDS funding would result in reduced coverage of HIV/AIDS prevention and treatment programmes. “It is likely that a full range of services will continue to be provded, but we will see more limited coverage,” he said. Countries that present proposals meeting the criteria for funding are most likely to receive it. Ruth Levine, an economist at the Center for Global Development, Washington, DC, said: “Unfortunately, the prettiest proposals win all too often.”
Dr de Lay explained the importance of forward planning for AIDS funding: “Estimating the resources available for AIDS is a relatively new exercise. Before 2001, this type of planning was not being done in a systematic way.” He added: “It offers improved ability to track resources from different funders.” Data are collected annually for international donors, and information on domestic resource flows in developing countries is gathered every two years.
Domestic spending on HIV and AIDS has increased significantly in many developing countries, including some of the poorest. In the Abuja Declaration, made in 2001, African countries pledged to earmark 15% of their national budgets for health spending. The UNAIDS report acknowledged that a third of the resources necessary to manage AIDS could come from domestic sources in low income countries. “But the balance will need to come from international sources,” it pointed out. In some areas—including sub-Saharan Africa and parts of Asia, up to 80% of the total resources will have to come from international funding.