Donors

A new report released today highlights the impact of the United Kingdom’s decision to cut its level of official development assistance from 0.7% to 0.5% of gross national income. The report, Jeopardising Progress: Impact of UK Government AIDS Cuts on HIV/AIDS Worldwide, is the work of the All-Party Parliamentary Group on HIV/AIDS, Stop AIDS and Frontline AIDS.

The report warns that the world is sleepwalking towards a new AIDS emergency and says that urgent action is needed to get the HIV response back on track. It shows how COVID-19 has disrupted HIV services, leading to significant declines in HIV testing and referrals to treatment around the world.

The UNAIDS Executive Director, Winnie Byanyima, met British parliamentarians to discuss the findings of the report during her visit to London earlier this month.

Ms Byanyima also met the Secretary of State for Health, Sajid Javid, and the Minister for European Neighbourhood and the Americas at the Foreign, Commonwealth and Development Office, Wendy Morton. During the meetings, Ms Byanyima praised the United Kingdom’s own progress against the HIV epidemic and said the country’s leadership and participation in the global AIDS response was needed now more than ever.

The increase was largely due to disbursement of prior-year multilateral funds. Bilateral funding from donor governments, other than the U.S., continues a downward trend.

A new report from KFF (Kaiser Family Foundation) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) finds that donor government disbursements to combat HIV in low-and middle-income countries increased by US$377 million in 2020, reaching US$8.2 billion in 2020 compared to US$7.8 billion in 2019. Donor government funding supports HIV care and treatment, prevention, and other services in low- and middle-income countries.

The rise in funding is almost entirely the result of an increase in United States contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which was due largely to the disbursement of prior-year funding. U.S. disbursements to the Global Fund are not expected to remain at this level in 2021.

The United States continues to be the largest donor to HIV, accounting for 76% of all donor government funding, followed by the United Kingdom (US$612 million, 7%), Japan (US$258 million, 3%), Germany (US$246 million, 3%), and France (US$216 million, 3%). As other donor governments continue to pull back bilateral funding, the United States accounts for an increasing share of overall funding for HIV from donor governments.

The report reflects prior-year political and funding decisions and does not fully capture the impact of COVID-19 on donor funding decisions.

“While many donor governments are beginning to bounce back from the pandemic, its global impact and related recession make future funding for HIV response unpredictable,” said KFF Senior Vice President Jen Kates. “Not only are some low- and middle-income countries experiencing a ‘third-wave’ of COVID-19, vaccines remain largely out of reach, potentially leading to greater funding needs for HIV and other health services.”

"We are at a critical stage in the AIDS response as countries are confronting the huge challenges posed by the COVID-19 pandemic," said Winnie Byanyima, Executive Director of UNAIDS. "But we do still have an opportunity to end the epidemic by 2030 if donors and countries alike commit to mobilize resources and prioritize health, human rights and equality which are the key components, not only to lead us out of the pandemics of HIV and COVID-19, but they are the cornerstone to economic recovery and security."

These data are included in a broader UNAIDS global report, which examines all sources of funding for HIV relief, including local governments, non-governmental organizations, and the private sector, and compares it to the resources needed to achieve goals related to testing and treatment.

The new report, produced as a long-standing partnership between KFF and UNAIDS for more than 15 years, provides the latest data available on donor government funding based on data provided by governments. It includes their bilateral assistance to low- and middle-income countries and contributions to the Global Fund, UNAIDS, and UNITAID.  “Donor government funding” refers to disbursements, or payments, made by donors.

The goal of putting the HIV response on a secure financial footing is a work in progress, with uneven results around the globe towards ensuring a sustainable, fully funded, effective, equitable and gender-sensitive HIV response. The 2020 target to mobilize at least US$ 26 billion for the HIV response was not met. Other targets, such as implementing efficiency measures to optimize the use of existing resources and to clear bottlenecks in scaling up services, were also missed.

A panel, Resources and Funding for an Effective AIDS Response, held on the sidelines of the United Nations High-Level Meeting on AIDS, deliberated on how to reach a sustainable, fully funded, equitable and effective HIV response in a challenging environment for health and development resources.

The panellists surveyed the current situation and key actions for the road ahead, addressing several questions: What does a sustainable, fully funded, equitable and effective HIV response look like? How can the necessary funding levels be secured in the challenging resource environment that we face? What steps can and should we take to improve the impact/effectiveness of the available resources? Are there opportunities that need to be better leveraged within the HIV response, the broader health agenda and the broader development agenda? How can we ensure that we invest in the right interventions for the right populations and places to meet the new global targets and achieve the collective goal of Sustainable Development Goal 3? 

Key actions identified by the panellists to guide future efforts include the following:

• Better targeting interventions to achieve equity and impact based on diverse and locally specific needs and goals.
• Approaches and measures to secure the necessary funding mixes, including ongoing international support and appropriate and sustainable domestic funding, and improved equity and efficiency in using those resources.
• Better integration of HIV into other health and development efforts, including universal health coverage, health system strengthening, pandemic preparedness and response and enablers, such as education and social protection, and to better link and leverage those efforts to maximize impact for people living with, at risk of or affected by HIV.
• The importance of ensuring that critical cross-cutting factors, such as gender-sensitivity, eliminating inequalities, leveraging data and prevention, are appropriately supported and integrated throughout.
• The need for shared responsibility, which calls for countries that can pay for their own responses to do so fully, and for those without the ability to pay, to be supported by donors as part of global solidarity.

The panel also examined how investments in the HIV response can help to reduce vulnerabilities and societal inequalities and how to catalyse more effective social spending using a rights-based, people-centred model that empowers individuals and communities. 

Finally, the panel situated the discussion in the broader development and fiscal contexts by exploring the economics of HIV, as well as how to tackle inequalities and use people-centred HIV responses to put us on track to reach Sustainable Development Goal 3. It addressed the costs of inaction and complacency, not only for the HIV response but also across the Sustainable Development Goals. Looking at fiscal realities, the panellists provided a broader analysis of the current situation and thoughts on the way forward for protecting and expanding the much-needed fiscal, budgetary and policy space through measures such as tackling public debt distress, tax injustice and illicit financial flows.

HIV is fuelled by inequalities. A panel, Addressing Inequalities to End AIDS: 10 Years to 2030, held on the sidelines of the United Nations High-Level Meeting on AIDS on 9 June, brought together a passionate mix of grass-roots activism and experience, academic wisdom, evidence-informed strategic guidance and experience from United Nations Member States and UNAIDS to discuss this urgent issue.

All the panellists underlined the need for urgent, evidence-informed and transformative action to unlock social enablers and to end the social, economic, racial and gender barriers—which include punitive laws, policies and practices, stigma and discrimination based on HIV status, sexual orientation and gender identity, and other human rights violations—that create and deepen the inequalities that perpetuate the HIV pandemic. They shared strategies and action for ending the HIV epidemic based on lived experience and backed by lessons from four decades of the HIV response.

The panellists underlined lessons from HIV and COVID-19 that have shown the world that unless all countries, communities and individuals access the benefits of science and technology without stigma and discrimination, benefit from fair taxation and equitable distribution of wealth and are respected in all their diversity, epidemics will continue to rage.

The participants heard that six out of seven new adolescent HIV infections in sub-Saharan Africa are among girls—Winne Byanyima, the Executive Director of UNAIDS, noted that this was because of inequalities of power. The participants also heard, though, that strong political commitment to ensure that prevention services were available at the community level, with a special focus on reaching adolescent girls and young women and their partners, saw Eswatini successfully meet its HIV prevention targets.

Jeffrey Sachs, a professor at Columbia University, in the United States of America, reminded the participants that well laid out goals and time-bound and evidence-informed plans must be matched by adequate financing, without which poorer nations and poorer communities even within rich nations will not enjoy good health and well-being.

The powerful testimony of Abhina Aher, a transgender activist from India, spoke of the multiple, intersecting and dynamic inequalities faced by a person who does not conform to the social norms of mainstream Asian society.

Thanks @benphillips76 let’s unite to end inequalities #HLM2021AIDS #HLMAids2021 https://t.co/bhwY7nf0UZ

— Abhina Aher (@meisabheena) June 9, 2021

All the participants underlined the centrality of enabling laws and policies and of the need for comprehensive sexuality education to empower young people to make informed decisions about relationships and sexuality and navigate a world where gender-based violence, gender inequality, early and unintended pregnancies, and HIV and other sexually transmitted infections still pose serious risks to their health and well-being.

Interventions from representatives of the Bahamas, Germany, Mexico, Spain and the United Kingdom of Great Britain and Northern Ireland underlined the urgency of an HIV response that addresses gender inequalities and protects and enables human rights.

In summary, it was concluded that inequalities both feed and drive the HIV epidemic as well as other diseases, but that inequalities should be fought with the right policies, strategies and legislation in order to end AIDS by 2030 and at the same time strengthen pandemic preparedness. 

GENEVA, 29 April 2021—The government of the United Kingdom of Great Britain and Northern Ireland (UK) has informed UNAIDS that funding for UNAIDS for 2021 is confirmed at GBP 2.5 million, compared to the GBP 15 million received by UNAIDS from the UK for 2020.

This cut of GBP 12.5 million (or more than 80%) is significant. It affects the provision of live-saving HIV prevention and treatment services around the world. It affects the empowerment of young women and adolescent girls and their access to sexual and reproductive health and rights across the world, and Africa in particular. It impacts on support to upholding the human rights of some of the most marginalized people, including lesbian, gay, bi-sexual, transgender, queer and intersex people in low- and middle-income countries. It reduces global health security.

UNAIDS recognizes the challenging situation facing many governments, yet deeply regrets this decision of our longstanding partner and advocate. We are assessing the full scope and impact of the cut and are actively formulating mitigation strategies.

The UK government has said the decision does not reflect a diminished commitment to UNAIDS or the HIV response. UNAIDS will continue working with the UK and partners to explore ways to ensure continuity and predictability of funding to sustain the hard-won gains in the fight against HIV and to end AIDS as a public health threat by 2030.

The UK has been a leader in the fight against AIDS. It has called for the G7 to be centred on beating pandemics and is rallying the world for girls’ education and empowerment. UNAIDS is determined to deliver breakthroughs on those together with the UK. We hope that the UK, which has rated UNAIDS ‘A’ for delivery, will decide to supplement its current allocation for 2021.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

GENEVA, 18 March 2021—UNAIDS warmly welcomes the passing of the US$ 1.9 trillion American Rescue Plan Act. The historic legislation will deliver much-needed relief in the light of COVID-19, both in the United States of America and around the world.

The bill’s inclusion of nearly US$ 11 billion for global investments in COVID-19 will help to save many lives. The allocation of US$ 250 million for the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and US$ 3.5 billion for the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) will help to prevent hard-won progress against HIV, tuberculosis and malaria from being reversed.

“The support of the United States for the global response to COVID-19 is highly commendable, particularly as it grapples with the devastating impact of COVID-19 at home,” said Winnie Byanyima, Executive Director of UNAIDS. “With the American Rescue Plan Act the United States proves again its steadfast commitment to the AIDS response and to fighting other global pandemics. We look forward to continuing our strong partnership with the United States in our shared commitment to end AIDS and to overcome COVID-19,” said Ms Byanyima.

Generous bipartisan support from the United States has allowed great strides to be made against the AIDS pandemic. Investments made by the United States over the past 18 years through PEPFAR and the Global Fund have proved transformational—they have prevented millions of HIV infections and saved the lives of millions of people. People living with HIV who are on antiretroviral therapy can now enjoy long, healthy lives and the number of new HIV infections and AIDS-related deaths are on the decline, although the rate of decline is still far too slow.

“Despite the tremendous successes, the work is unfinished. AIDS remains an urgent global health crisis,” said Ms Byanyima.

Global averages conceal the reality that too many people are still being left behind. The world did not reach the 2020 Fast-Track prevention and treatment targets committed to in the UNAIDS 2016–2021 Strategy and the United Nations Political Declaration on Ending AIDS. Many countries and communities are not currently on track to end AIDS by 2030.

While 26 million of the 38 million people living with HIV are accessing life-saving treatment, which doubles as prevention by stopping the spread of the virus, another 12 million remain without. The rate of new HIV infections, especially for adolescent girls and young women in sub-Saharan Africa and members of key populations, remains high. In 2019, a further 1.7 million people worldwide were newly infected with HIV and 690 000 people died of AIDS-related illnesses. The rate of new HIV infections and deaths, especially among the hardest to reach populations, means that continued success requires greater effort, focus and commitments. This is doubly true as COVID-19’s impact puts added pressure on the HIV response.

“The global response to AIDS was off track prior to COVID-19. Unchecked, COVID-19 threatens to reverse valuable progress made against HIV. This confluence of pandemics requires an acceleration of efforts to close the gaps in HIV testing, prevention and treatment while working to stop COVID-19’s spread,” said Ms Byanyima. “Identifying where, why and for whom the HIV response could be improved has illuminated the inequalities, within and between countries, that contribute to the spread of HIV. The stark contrast of success in some places and among some groups of people and the failure in others confirms that HIV remains a pandemic of inequalities. That is why the new global AIDS strategy 2021–2026 contains new targets to help us reach those who are being left behind.”

Fortunately, investments in accelerating the HIV response do not come at the expense of the COVID-19 response, but rather support many of its most critical requirements. Nations combatting COVID-19 are already applying lessons learned from the HIV response, using the systems, human resources, know-how and laboratories built over the past two decades.

Efforts to reinforce and leverage the infrastructure built to end AIDS can optimize the health impact and sustainability of the response to COVID-19. Leveraging the experience of the HIV response offers a unique opportunity to build back better from COVID-19.

“These new investments from the United States in COVID-19 will save many lives in low- and middle-income countries and help strengthen the health systems that deliver care for HIV, COVID-19 and other health emergencies,” added Ms Byanyima.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

GENEVA, 3 February 2021—UNAIDS warmly welcomes the announcement by the President of the United States of America, Joe Biden, that he has rescinded the Protecting Life in Global Health Assistance Policy (PLGHA, previously known as the Mexico City Policy). The policy required foreign nongovernmental organizations to certify that they would not perform or actively promote abortion using funds from any source (including non-United States funds) as a condition of receiving United States Government funding.

“Rescinding the PLGHA is a strong demonstration of the new United States Administration’s commitment to supporting women to claim their rights and to access sexual and reproductive health and rights information and services,” said Winnie Byanyima, UNAIDS Executive Director. “We look forward to working closely with the new United States Administration to ensure that all women and girls can exercise their human rights and get the sexual and reproductive health information and services they want and need.”

The former United States Administration took previous restrictions established by the Mexico City Policy to a new level by applying the policy to global health assistance provided by all executive departments and agencies. This severely limited access to critical sexual and reproductive health-care services and stifled local advocacy efforts, in turn undermining human rights in general and sexual and reproductive health and rights in particular worldwide.

UNAIDS welcomes the White House’s call to waive conditions related to the PLGHA in any current grants with immediate effect, to notify current grantees, as soon as possible, that these conditions have been waived and to cease imposing these conditions in any future assistance awards.

“Women and girls having full access to their sexual and reproductive health and rights is closely connected to their overall safety, health and well-being. We hope that this will inform the passage of the Global Health, Empowerment and Rights Act—legislation designed to permanently repeal the PLGHA,” added Ms Byanyima.

UNAIDS also warmly welcomes the announcement by the President that the United States will restore funding to the United Nations Population Fund (UNFPA), a key UNAIDS cosponsoring organization working around the world to provide reproductive health care for women and young people. UNAIDS appreciates the commitment by the United States Secretary of State, Anthony Blinken, to appropriate US$ 32.5 million in support for UNFPA this year.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.