Donor government funding for global HIV programs shows no increase in 10 years
For the second year in a row, UNAIDS warns that progress in reducing new HIV infections, increasing treatment access, and ending AIDS-related deaths is not keeping pace with targets and urgent action is needed to get the world back on track. Three recent reports show a mixed global response, with some countries making significant progress and others seeing increases in new HIV infections and AIDS-related deaths.
Global Gains Are Slowing, Results Are Mixed
“We urgently need increased political leadership to end AIDS,” said Gunilla Carlsson, UNAIDS Executive Director, in a new UNAIDS Global AIDS Update. “This starts with investing adequately and smartly and by looking at what’s making some countries so successful. Ending AIDS is possible if we focus on people, not diseases, create road maps for the people and locations being left behind, and take a human rights-based approach to reach people most affected by HIV.”
From left, Dr. Zweli Mkhize, Minister of Health, South Africa; Gunilla Carlsson, UNAIDS Executive Director; David Mabuza, Deputy President, South Africa
Among the report’s findings:
- Key populations are still being marginalized and left behind. In 2018, more than half (54%) of new HIV infections around the world occurred in key populations, including people who inject drugs, gay men and other men who have sex with men, transgender people, sex workers, and prisoners.
- Prevention efforts need to be stepped up, even in regions that have shown remarkable gains. Proven prevention strategies, such as pre-exposure prophylaxis (PrEP) and harm reduction for people who inject drugs, are not being used to maximum effect.
- There have been troubling increases in new HIV infections in Eastern Europe and Central Asia (29%), the Middle East and North Africa (10%), and Latin America (7%).
- There has been progress toward the 90-90-90 targets. In 2018, about 79% of people living with HIV knew their status, 78% who knew their HIV status were accessing treatment, and 86% of people living with HIV who were accessing treatment were virally suppressed. But there are huge regional variations.
- AIDS-related deaths are falling. Since 2010,AIDS-related deaths have declined by 33%.
- The rate of new infections among young women has gone down 25% since 2010, but young women are still 60% more likely than young men to acquire HIV.
- Stigma and discrimination still impede the HIV response.
The World Must Accelerate Its Commitment to Children and Adolescents
Start Free, Stay Free, AIDS Free, a UNAIDS report released at the 10th IAS Conference on HIV Science in Mexico City, shows that progress in lowering the rate of new HIV infections among children and expanding access to treatment for children, adolescents, and pregnant women living with HIV has slowed significantly. About 90% more pregnant women living with HIV are accessing antiretroviral therapy compared with 2010, with a corresponding 41% decrease in new HIV infections in children. Yet in 2018 there were about 160, 000 new HIV infections among children, far from the target of fewer than 40,000. Children and adolescents are also not being diagnosed and treated at the same rate as adults, and are less likely to be virally suppressed.
“The failure to reach the 2018 targets to reduce new HIV infections among children and adolescents and to widen access to life-saving treatment is both disappointing and frustrating,” said Ms. Carlsson. “We need to act quickly to turn this situation around and honor the commitment to end the AIDS epidemic for the next generation.”
Donor Funding Has Flattened
A new analysis from the Kaiser Family Foundation (KFF) and UNAIDS reports that donor governments spent $8 billion on the global HIV epidemic in 2018, similar to levels from ten years ago. When all funding sources are taken into account, data show a $1 billion decline in global funding for HIV programs. After adjusting for inflation, this leaves a $7 billion gap between resources and need in 2020.
“Since the global financial crisis a decade ago, donor governments’ support for HIV has flattened and funding from donors other than the U.S., which has held steady, has gone down,” said KFF Senior Vice President Jen Kates. “Unless this calculus changes, efforts to prevent and treat HIV globally will need to rely increasingly on other sources of funding."