JOHANNESBURG, 12 November 2009 (PlusNews) - 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
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
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
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
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
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."