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Despite Substantial Increases, AIDS Funding Is Still Only Half of What Will Be Needed By 2005 - Social and Economic Policy - Global Policy Forum Despite Substantial Increases,
AIDS Funding Is Still Only Half of What Will Be Needed By 2005Global AIDS Spending Has Increased Nine-fold Since 1996
UNAIDS
June 26, 2003
A new UNAIDS report estimates that US$4.7 billion will be spent to address the AIDS epidemic in 2003 in low- and middle-income countries, falling far short of the more than US$10.5 billion that will be needed annually by 2005 to effectively fight the epidemic in these countries. The finding is contained in UNAIDS' latest report on global HIV/AIDS funding, released for its Programme Coordinating Board (PCB) meeting, taking place in Geneva today and tomorrow."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," said Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). "Although we are half way there in closing the AIDS funding gap, there is still half way to go."
The US and European nations have recently announced their intention of increasing AIDS funding, through bilateral and multilateral channels, and the new Global Fund to fight AIDS, Tuberculosis and Malaria. If realized, these announcements would translate into additional annual spending of US$1.2 billion by 2005 - leaving a gap which is still nearly US$5 billion. "It is important that announced funding increases for 2004 are converted into funds that reach prevention and care programmes on the ground," said Dr Piot. "But it is even more important that spending keeps on increasing through 2005, and beyond".
According to the report, spending by governments, international organizations, foundations and NGOs increased nine-fold from 1996 to 2002, from just under US$300 million to over US$2.8 billion. The total spending estimate of US$4.7 billion in 2003 in low- and middle-income countries includes US$1.6 billion in international bilateral assistance spending, a further US$1 billion in multilateral and Global Fund spending, US$1 billion in projected spending by governments in affected countries, and household spending in those countries of just over US$1 billion.
However, according to UNAIDS and WHO estimates, over US$10.5 billion a year will be needed in 2005 for a "barebones" package of prevention, treatment, care and support programs in low- and middle-income countries. By 2007, almost US$15 billion will be needed. These estimates take into account both declines in the price of antiretroviral drugs and the inclusion of 25 interventions - 17 types of prevention services, 5 types of treatment and care services and 3 types of orphan support.
"We have come a long way in committing additional resources to fight HIV/AIDS, but much more still needs to be done," said Dr Piot. "Additional resources need to be rapidly mobilized at both the international and national levels if we are going to meet the US$10.5 billion target by 2005." The global threat of HIV/AIDS requires global action-not least in ensuring that sufficient funding is available in those countries and communities most in need. Despite considerable, recent progress on this front, funding still falls far short of the need.
Funding on the Rise-but Still Too Low
UNAIDS estimates that disbursements from private, national and international sources for 2003 will total about US$4.7 billion in low- and middle-income countries-a considerable increase in the past five years. Domestic spending on HIV/AIDS has increased significantly in many countries, including some of the poorest. In 2001, the Abuja Declaration included a pledge by African countries to earmark 15% of their national budgets to health spending. But poor countries still struggle to boost their spending-even to levels that fall far short of the need. As a result, millions of people living with HIV/AIDS have to pay for their own health care. In Rwanda, for example, out-of-pocket spending-money individuals spend on HIV/AIDS services themselves-represented 93% of total AIDS spending in 1998-1999. Bridging the gap
The latest estimates by UNAIDS on the cost of effective prevention, treatment, care and support programs in low- and middle-income countries indicate that more than US$10.5 billion will be needed in 2005. Financial resource needs will continue to increase significantly so that by 2007 some US$15 billion a year will be needed to successfully combat AIDS. That level will have to be maintained for at least a decade thereafter. To meet the more than US$10.5 billion needed to fight the epidemic in 2005, funding from all sources will have to more than double from 2003 levels. A third of the total resources necessary could come from domestic sources in low-income countries, but the balance will need to come from international sources. Up to 80% of the total resources needed in sub-Saharan Africa and parts of Asia will have to come from international sources. Meanwhile, Official Development Assistance to low- and middle-income countries still falls short of long-standing commitments. The funding shortfall cannot be met by a single source. Several distinct funding sectors are involved in responding to AIDS, each of which has its own comparative advantages. The Global Fund to Fight AIDS, Tuberculosis and Malaria
Operating since January 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria represents a new approach that emphasizes national ownership and country-led activities, as well as simplified, rapid and innovative processes. As a global, public-private partnership, it attracts, manages and disburses new resources to programs in countries with the greatest need. HIV/AIDS prevention projects.
The Fund is not meant to replace current efforts, but to complement other funding initiatives by raising additional resources.
The Fund's Board includes country representatives (from both developing and high-income countries), as well as representatives from the business sector, nongovernmental organizations and communities directly affected by the epidemic. UNAIDS, WHO and the World Bank are non-voting members of the Board.
Total pledges to the Fund stood at US$4.6 billion in June 2003. The majority of these funds are from donor countries' Official Development Assistance budgets and the endowments of major philanthropies.
In its two rounds of program proposals and approvals, the Fund approved US$1.5 billion to 153 programs in 92 countries. A third round of proposals is envisaged, with a decision expected this fall. The Multi-Country HIV/AIDS Program for Africa (MAP)
Managed by the World Bank, the Program takes the form of zero-interest loans and, since last fall, grants for eligible countries, that support government efforts to increase access to HIV/AIDS prevention, care, support and treatment programs, as well as to mitigate the epidemic's impact.
The Program's first stage, worth US$500 million, was approved in September 2001. The initial funds, supported 13 countries in sub-Saharan Africa. In February 2002, the Bank allocated an additional US$500 million, which will support another 12-15 countries. (The Program is also intended to support sub-regional and cross-border initiatives.)
A similar initiative is now under way in the Caribbean. Totaling US$155 million, the Multi-Country HIV/AIDS Prevention and Control Project for the Caribbean works as a five-year loan program that allows countries to obtain separate loans or credits to finance their national HIV/AIDS prevention projects. Debt Relief
Reducing the debt burdens of poor countries also has the potential boost the AIDS response where it is most needed. The debts of the 38 highly indebted poor countries (HIPC) amount, on average, to more than four times their annual export earnings. These debt servicing obligations can undermine a country's social spending, including that required for HIV/AIDS and orphan responses.
In 16 African countries in 2001, governments were still spending more on servicing debts than on the health of their citizens. The HIPC debt initiative, devised by the World Bank and the International Monetary Fund, is an attempt to relax those constraints.
Under the initiative, eligible countries qualify for debt relief if they meet certain conditions, including the adoption of economic adjustments and the drafting of poverty-reduction strategies in which social spending is given priority. Countries are encouraged to add HIV/AIDS programs to these strategies. The Business Sector
The business sector has an important role to play in the AIDS response, supporting prevention, treatment and care programs. Approximately seven per cent of the total resource need is for workplace prevention, which private enterprises can fund, for example. For more information, please contact Dominique De Santis, UNAIDS, Geneva, (+41 22) 791 4509, or Gavin Hart, UNAIDS, New York, (+1 212) 584 5016. You may also visit our website, www.unaids.org, for more information about the programme.
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