Press release

UNAIDS warns that HIV, COVID and other health investments are in danger due to a looming debt crisis in Africa and the developing world

In 2020 highly indebted countries already used four times more of their revenues on debt repayments than on health investments, reveals UNAIDS report A Pandemic Triad. The report was presented at an event hosted by Georgetown University in Washington DC during the Annual meetings of the International Monetary Fund (IMF) and the World Bank

WASHINGTON/GENEVA, 13 October 2022—COVID-19 and the debt crisis, now aggravated by the consequences of the war in Ukraine, have created an unprecedented setback in global health, and put the global response to AIDS in jeopardy, risking 7.7 million deaths to AIDS-related causes by 2030, according to a new report by UNAIDS.

The report, A Pandemic Triad, shows that the debt crisis and the war in Ukraine have deepened the fiscal crisis of developing countries, severely undermining their capacity to invest in health. It also shows that the countries most affected in economic terms by COVID-19 are the countries deepest in debt—they are also the countries most affected by HIV. In 2020, for every US$ 10 available, US$ 4 was spent on debt servicing and only US$ 1 was invested in health.

“The multilateral system cannot fail again,” said Winnie Byanyima, Executive Director of UNAIDS. “The response to COVID was dramatically inadequate, from very limited vaccination in developing countries to no permanent debt relief, and scarce fresh resources to countries with severe health and social problems—there can be no mistakes this time.”

The World Bank is forecasting that, without even including the latest numbers, 110 countries will have health spending in 2027 either under 2019 levels or slightly over, with only 67 countries. going above 2019 pre-COVID health investment levels.

The 2020 data show that there was a temporary increase in health spending, but it was focused predominately on the COVID emergency, leaving other health priorities behind. Latest forecasts from the IMF predict slower economic growth, higher inflation and worsening debt risks, leaving health and HIV investments under severe threat.

“We need a brave multilateral response to enable developing countries to respond to current pandemics and prevent future ones, while tackling the urgent food crises,” said Ms Byanyima. “Growing development cooperation, closing tax loopholes and promoting progressive taxation, providing fast and effective debt cancellation and relief, and avoiding the resource to austerity that would mean less doctors, nurses, midwives, is the way to go. New resources and resources freed from debt or tax dodging should be invested wisely to end AIDS by 2030 and respond effectively to future pandemics.”

A Pandemic Triad shows that of the 38 million people estimated to be living with HIV, 26 million are in developing countries and two thirds are in countries that received absolutely no debt relief at all despite the deep health and economic crisis brought by COVID.

The HIV response in low- and middle-income countries is US$ 8 billion short of the amount needed by 2025. In 2021, international resources for HIV were 6% lower than in 2010. It is estimated that the reduced availability of resources to finance access to HIV services could cost 7.7 million lives over the next decade.

The Global Fund to Fight AIDS, Tuberculosis and Malaria is seeking additional resources for countries´ investments in the fight against the three diseases.

Kalipso Chalkidou, Head of Health financing at the Global Fund said, “As the latest IMF World Economic Outlook figures illustrate, the outlook is dire for donor and recipient countries alike, with debt servicing severely constraining especially poorer nations' ability to spend in health and social causes. In this environment, Global Fund views debt swaps for health as a promising tool for creating badly needed fiscal space to invest in health systems and the three diseases."

On average, public debt levels in low- and middle-income countries rose from 55% to 63.8% of GDP between 2019 and 2020 equivalent to a staggering US$ 2.3 trillion and continue spiraling. Meanwhile currency depreciation to the US dollar of over 10%, and escalating interest rates payments are creating a perfect debt storm. For low-income countries (LICs), total debt is estimated at 87% of GDP. As a consequence, the proportion of LICs in debt distress, or at high risk of debt distress, has doubled to 60% from 2015 levels.

OXFAM presented the update of the commitment to Reduce Inequality Index at the Annual meetings and presented the latest data around inequalities in access to health.

Max Lawson, Head of Inequality Policy and Advocacy at Oxfam International said, “Our analysis shows that half of the poorest countries cut health spending, despite the worst health crisis in century. They are spending far more on repaying their huge debts to rich creditors in New York and London than they are able to spend on protecting their people from dying from diseases. This is an appalling situation, made more appalling because it does not have to be this way. Inequality is a policy choice, not an inevitability”.


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 and connect with us on Facebook, Twitter, Instagram and YouTube.


Sophie Barton-Knott
tel. +41 79 514 6896

Press centre


The World Bank

Watch: Webinar to launch report

Pandemic triad: HIV, COVID-19 and debt in developing countries

Watch: Jaime Atienza Azcona, Director, Equitable Financing, UNAIDS explains the report