Resources and funding

GENEVA, 19 November 2021—Having experienced major shortfalls in funding since 2015, UNAIDS convened donors, partners and Programme Coordinating Board members in Geneva, Switzerland, for a dialogue to help bolster UNAIDS’ efforts in supporting countries to end AIDS by 2030 as part of the Sustainable Development Goals.

During the meeting, held on 15 November 2021, UNAIDS warned that despite a growing number of countries demonstrating the feasibility of ending AIDS as a public health threat, the global HIV response is faltering, resulting in a slowing decline in new HIV infections and AIDS-related deaths. Around 1.5 million people became newly infected with HIV in 2020, and every 60 seconds someone died of an AIDS-related illness. Without an immediate course correction and renewed momentum, UNAIDS fears that hopes for reaching the 2030 target of ending AIDS could vanish.

“As we move into the next phase of the AIDS response, the risk of political neglect increases as the epidemic concentrates among the most marginalized, discriminated against and criminalized—key populations and adolescent girls and young women,” said Winnie Byanyima, Executive Director of UNAIDS. “The Joint Programme is needed now more than ever.”

The meeting was held to deepen the understanding of the work of UNAIDS and its critical role in global health. Speakers highlighted that since its inception in 1996, UNAIDS has brought unique value to the global AIDS response, leveraging the combined strengths of the United Nations system, leading efforts to expand access to HIV prevention, treatment and care services, increasing global resources for HIV, building political commitment and collecting data to build evidence-informed responses.

The Chair of the UNAIDS Programme Coordinating Board demonstrated how UNAIDS’ support has adapted to and been critical in the COVID-19 crisis. “In Namibia, we have seen very clearly the contribution of UNAIDS during this very difficult past year as we experienced an exponential increase in COVID-19 cases, hospitalizations and deaths,” said Julia Imene-Chanduru, representing the Chair of the UNAIDS Programme Coordinating Board. “Our health system was severely overstretched. During this time, UNAIDS supported Namibia to ensure the continuity of treatment for people living with HIV by supporting us to move to multimonth dispensing of antiretroviral treatment and assisting us in strengthening community engagement for COVID-19 and HIV.”

Speakers emphasized that UNAIDS has also been instrumental in tackling stigma and discrimination and fighting for equality and human rights. Overall, these unique, essential contributions from UNAIDS account for less than 1% of all funding available for HIV activities in low- and middle-income countries.

“Our health is a bedrock not only for life itself, but it is essential to achieving the Sustainable Development Goals,” said Amina Mohammed, Deputy Secretary-General of the United Nations. “UNAIDS is smart and brings transformative action to life. Of the total global funding for HIV, the 1% that UNAIDS represents helps leverage billions more. I urge you to continue to increase your contributions to this organization and support its incredible life-saving work.”

Since 2015, UNAIDS has experienced severe shortfalls in funding. For 2020 and 2021, UNAIDS had an approved annual budget of US$ 242 million. In 2020, UNAIDS raised US$ 194.1 million, but is expected to raise only US$ 165 million in 2021. The meeting provided an opportunity to deepen the understanding of donors of the work of UNAIDS and warned of the cost of inaction or insufficient funding.

“Our current funding situation limits what is possible and what can be made possible,” said Ms Byanyima. “It is time to invest. It is time to match our political ambition and equip all our stakeholders to drive the response forward and help realize the human right to health for all.”

“It is our responsibility as the Joint Programme to put AIDS back on the development agenda. But not only with the speeches but also with budgets. The call of the nongovernmental organization delegation is that we want a fully funded UBRAF. We want a fully funded UNAIDS and fully funded AIDS response,” said Gracia Violeta Ross Quiroga, National Chair of the Bolivian Network of People Living with HIV/AIDS (REDBOL).

UNAIDS urges donors and partners to create momentum around potential opportunities and mutual commitments relating to funding UNAIDS and the AIDS response, including prioritizing resource allocation and priority-setting. UNAIDS urges donors to ensure adequate, predictable and flexible funding for UNAIDS through multi-year agreements for core and non-core funding to fully support UNAIDS’ efforts to end AIDS by 2030.

“We reiterate calls that have been made today by the Secretariat and Cosponsors for funding to be predictable and sustained in order to enable the Joint Programme to deliver on our common goals. Kenya remains committed to supporting this process and stands ready to engage in any subsequent discussions,” said Peace Mutuma, Health Attaché, Permanent Mission of Kenya to the United Nations in Geneva.

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.

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.

A new report published by UNAIDS today shows the value of investing fully in the HIV response.

UNAIDS modelling shows that investing US$ 29 billion a year in the HIV response in low- and middle-income countries by 2025 will put the world back on track to end AIDS by 2030. The investment, paid for by both donors and the wealthier countries most impacted by the HIV pandemic, would result in annual new HIV infections falling dramatically, from 1.7 million in 2019 to 370 000 in 2025, and annual AIDS-related deaths falling from 690 000 in 2019 to 250 000 in 2025. The number of new HIV infections among children will drop from 150 000 in 2019 to less than 22 000 in 2025.

In 2016, countries agreed in the United Nations Political Declaration on Ending AIDS to invest US$ 26 billion in the HIV response by 2020. Resources in low- and middle-income countries peaked in 2017 but they started decreasing in 2018, with only US$ 19.8 billion available in 2019—just 76% of the 2020 target. As a result, none of the global programmatic targets set for 2020 were met. And the failure to achieve the targets has come at a tragic human cost: an additional 3.5 million people were infected with HIV and an additional 820 000 people died of AIDS-related illnesses between 2015 and 2020.

“We are not on track to end AIDS by 2030,” said Jose A. Izazola, UNAIDS Special Adviser, Resource Tracking and Finances. “But our modelling shows that spending wisely and focusing investment in the right place will have remarkable results and get us on track to end AIDS by 2030.”  

As a result of the failure to meet the 2020 targets, spending will have to be increased, to a peak of US$ 29 billion by 2025.

The investments will be made in a variety of areas. There will be substantially greater investments in HIV prevention services, for which investments will almost double, from the estimated US$ 5.3 billion expenditures in 2019 to US$ 9.5 billion in 2025, with a special focus on key populations, to stop the 1.7 million new HIV infections that still occur each year.

Huge gains can be made in the scale-up of HIV treatment at a low additional financial cost. Modelling shows that a modest 17% increase (an additional US$ 1.3 billion) in resources for testing and treatment by 2025 will enable a 35% increase in the number of people on treatment, to 32 million people.

Spending in societal enablers—factors rooted in society as a whole that modify the effectiveness of HIV programmes: access to justice and law reform, stigma and discrimination and gender equality, including gender-based violence—will more than double, from US$ 1.3 billion in 2019 to US$ 3.1 billion in 2025, and grow to 11% of total resource needs.

“We must not repeat the mistakes of the past,” added Mr Izazola. “The time to invest is now.”