Between 2012 and 2016, development assistance for HIV/AIDS decreased by 20.0%; domestic financing is therefore critical to sustaining the response to HIV/AIDS. To understand whether domestic resources could fill the financing gaps created by declines in development assistance, we aimed to track spending on HIV/AIDS and estimated the potential for governments to devote additional domestic funds to HIV/AIDS.
We extracted 8,589 data points reporting spending on HIV/AIDS. We used spatiotemporal Gaussian process regression to estimate a complete time series of spending by domestic sources (government, prepaid private, and out-of-pocket) and spending category (prevention, and care and treatment) from 2000 to 2016 for 137 low-income and middle-income countries (LMICs). Development assistance data for HIV/AIDS were from Financing Global Health 2018, and HIV/AIDS prevalence, incidence, and mortality were from the Global Burden of Disease study 2017. We used stochastic frontier analysis to estimate potential additional government spending on HIV/AIDS, which was conditional on the current government health budget and other finance, economic, and contextual factors associated with HIV/AIDS spending. All spending estimates were reported in 2018 US dollars.
Between 2000 and 2016, total spending on HIV/AIDS in LMICs increased from $4.0 billion (95% uncertainty interval 2.9–6.0) to $19.9 billion (15.8–26.3), spending on HIV/AIDS prevention increased from $596 million (258 million to 1.3 billion) to $3.0 billion (1.5–5.8), and spending on HIV/AIDS care and treatment increased from $1.1 billion (458.1 million to 2.2 billion) to $7.2 billion (4.3–11.8). Over this time period, the share of resources sourced from development assistance increased from 33.2% (21.3–45.0) to 46.0% (34.2–57.0). Care and treatment spending per year on antiretroviral therapy varied across countries, with an IQR of $284–2,915. An additional $12.1 billion (8.4–17.5) globally could be mobilized by governments of LMICs to finance the response to HIV/AIDS. Most of these potential resources are concentrated in ten middle-income countries (Argentina, China, Colombia, India, Indonesia, Mexico, Nigeria, Russia, South Africa, and Vietnam).
Some governments could mobilize more domestic resources to fight HIV/AIDS, which could free up additional development assistance for many countries without this ability, including many low-income, high-prevalence countries. However, a large gap exists between available financing and the funding needed to achieve global HIV/AIDS goals, and sustained and coordinated effort across international and domestic development partners is required to end AIDS by 2030.
Haakenstad A, Moses MW, Tao T, Tsakalos G, Zlavog B, Kates J, Wexler A, Murray CJL, Dieleman JL. Potential for additional government spending on HIV/AIDS in 137 low-income and middle-income countries: an economic modelling study. The Lancet HIV. 24 April 2019. doi: http://dx.doi.org/10.1016/S1473-3099(19)30165-3