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Background: Development assistance provided by donors to combat HIV/AIDS in low- and middle-income countries decreased by 6.6% between 2012 and 2017, following a decade of 19.6% in annual growth. These decreases are concerning because little is known about the magnitude of domestic resources spent on HIV/AIDS across the globe and within each country. There is also little evidence about whether declines in funding threaten the reductions in HIV/AIDS incidence and mortality achieved since 2000. We addressed this critical knowledge gap by quantifying HIV/AIDS spending, identifying the source of these funds, and measuring HIV/AIDS spending on prevention, care and treatment, prevention of mother-to-child transmission of HIV/AIDS (PMTCT), and antiretroviral therapy (ART).
Methods: We collected and extracted data from five main sources: the AIDSinfo online database, Global Fund proposals, National AIDS Spending Assessments, National Health sub-Accounts, and the AIDS data hub. A spatiotemporal Gaussian process regression model was used to estimate HIV/AIDS expenditure by source and function from 2000 to 2015. All currencies were converted to 2017 purchasing power parity dollars.
Results: In 2015, global HIV/AIDS spending amounted to $48.1 ($45.7-$52.1) billion, a decrease of $800 million from 2013. Governments financed 62.2% (56.6%-66.7%) of total HIV/AIDS expenditure and out-of-pocket expenditure financed 5.6% (4.9%-6.3%). Development assistance for HIV/AIDS comprised 30.2% (27.8%-31.7%) of total spending in 2015. Among low-income countries, $0.11 in government health spending for HIV/AIDS is spent for each dollar of development assistance. In high prevalence countries, development assistance constituted 76.6% (73.6%-79.4%) of HIV/AIDS spending. Since 2000, expenditure on prevention has increased by 273% to 11.2 billion, while spending on treatment increased by 271% to 23.6 billion. In 2015, total expenditure on ART and PMTCT was $6.3 and $7.7 billion respectively.
Conclusions: Government resources played a substantial role in growth in global HIV/AIDS spending. Still, development assistance remains a major portion of spending on the prevention and treatment critical to millions living with HIV/AIDS. This makes these programs susceptible to future cuts in spending. High prevalence countries reliant on international assistance must plan strategically so that drops in external financing do not alter progress towards an AIDS-free generation.