Mismatch between HIV spending and need

The global economic crisis may have the positive spinoff of forcing countries to allocate increasingly scare HIV/AIDS resources more efficiently.



A recent analysis of national spending on HIV/AIDS found a correlation between prevalence and the amount countries spent on the disease, but a mismatch between how the money was spent and the areas of greatest need.



Researchers from the AIDS Financing and Economics Division at UNAIDS and the Centre for Economic Governance and AIDS in Africa (CEGAA) used a tool developed by UNAIDS to track and report how much domestic and international funding was spent in eight different areas of HIV programming by 50 countries in 2006.



Their findings are published in a December supplement of the AIDS journal, which focuses on progress in achieving global HIV targets.



The data lends weight to recent calls by AIDS experts to concentrate dwindling resources for HIV/AIDS on well-managed interventions that have a strong evidence base.



Several countries with the highest HIV prevalence were found to be most dependent on external funding sources - and therefore the most vulnerable to potential cuts by donors in the economic downturn.



In the 17 low-income countries included in the analysis, 87 percent of HIV funding came from international donors, with bilateral assistance financing 53 percent of antiretroviral treatment.



Middle-income countries that rely mainly on domestic budgets to fund their HIV programmes, such as Botswana and Brazil, may also be forced to do more with less as their national revenues take a hit in the global financial crisis.



Botswana, with the second highest HIV prevalence in the world, had by the far the highest per capita spending on HIV in 2006 (US$70.40), followed by Swaziland ($17.30), while the remaining sub-Saharan African countries spent an average of $5.90 per capita.



Treatment and care absorbed large shares of overall HIV funding in many countries, leaving prevention initiatives underfunded; stigma and a lack of accurate HIV surveillance data on minority groups meant they were most often overlooked.



Countries with generalized epidemics (more than one percent of the population is HIV-positive) spent twice as much on treatment as on prevention, with about 30 percent of overall HIV expenditure going on prevention efforts.



Countries with concentrated epidemics (HIV infection is mainly confined to certain groups, such as injecting drug-users or sex workers) often spent most of their prevention budgets on broad programmes that missed the most at-risk populations.



In Latin American countries, for example, where an estimated 60 percent of people living with HIV are men who have sex with men, only 0.5 percent of funds for prevention were targeted at this group.

Read more:

Tailoring the HIV response to fit the epidemic

Economic downturn puts treatment of millions at risk

Prevention efforts and infection patterns mismatched

Time to start doing more with less money

The researchers concluded that most governments were not basing the allocation of HIV resources on a thorough understanding of their country's epidemic, nor were they opting for the most effective, evidence-based approaches.



"The global economic recession will force countries to rethink national strategies, especially in low-income countries with high aid dependency," they commented. "More than ever, countries need to know their epidemic, and both resource allocations and their HIV programmes need to reflect those data and analyses."



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