Global efforts to respond to the HIV epidemic were already falling short, with many countries not on track to meet the goal of ending Aids by 2030. The ongoing COVID-19 pandemic threatens to further derail this, with funding and resources being diverted away from HIV. Find out more about how there needs to be a more concerted effort to direct funding to programmes for key populations.
Resource details:
Publication title: Fast track or off track? How insufficient funding for key populations jeopardises ending Aids by 2030
Author(s): Bridging the Gaps, Partnership to Inspire, Transform and Connect the HIV response (PITCH), and Aidsfonds
Publication date: 20 October 2020
What the report is about:
Key populations are marginalised communities — such as men who have sex with men, transgender people, sex workers and people who inject drugs — which continue to be worst affected by the HIV epidemic. Funding that targets these groups is especially important to reduce the number of new HIV infections and effectively respond to this pandemic. With concerns that the ongoing COVID-19 pandemic will result in resources being diverted away from other public health concerns, this report provides the first global data on how much money is invested into an HIV response aimed at these key populations.
Key take-aways from the report’s findings:
- Key populations — such as men who have sex with men, transgender people, sex workers and people who inject drugs — made up just over half of new HIV infections in 2018.
- But only 11% of funding for HIV prevention programmes in lower- and middle-income countries was used to target these populations between 2016 to 2018.
- In 2016, UNAids estimated that a budget of around $6.8 billion was needed for HIV programmes targeting these groups. Yet only a fifth of this amount — $1.3 billion — was actually made available.
- In comparison, there was a shortfall of 22% when it came to broader HIV funding not specifically aimed at key populations.
How much was spent on key populations from 2016-2018:
- The risk of gay and bisexual men getting infected with HIV is 22 times higher than for all adult men, but programmes targeting gay and bisexual men only accounted for around 3% of HIV prevention funding.
- Roughly 0.3% of prevention funding goes towards programmes for transgender people, despite this community being 12 times more likely to acquire HIV than the general adult population.
- Although sex workers are 21 times more likely to get infected with HIV than the rest of the adult population, only 3% of prevention funding is targeted at this group.
- People who inject drugs accounted for 12% of all new HIV infections in 2018. Roughly 2% of prevention funding went to programmes for this group, which is 22 times more likely to contract HIV than the general population.
- Limited funding for these vulnerable groups means that each key population is only able to receive a fifth, or less, of the required resources.
Recommendations to get on track for ending the Aids epidemic by 2030:
- A total of $36.49 billion should be invested in HIV programmes specifically targeting key populations over the next decade.
- A bigger proportion of funding should go to community-led and community-based interventions, along with advocacy.
- There should be greater transparency around funding for key population HIV programmes, with funders making an effort to track this data and make it public.
- UNAids should monitor resource allocation to key groups and use this information to improve funding priorities among donors and governments.
Who’s funding key population HIV programmes in lower- and middle-income countries?
How does funding for key populations compare to HIV infections across different regions?
What the funding for key populations programmes looks like:
- Gay and bisexual men
- Only 0.58% — $333.4 million — of the total amount spent on the HIV response in lower- and middle-income countries went towards programmes targeting these men.
- Funding for this population increased annually over the three year period, starting in 2016.
- But in 2018, both Pepfar and the Global Fund decreased its funding for these groups.
- Despite the 2018 drop in funding, the Global Fund remains the biggest investor, making up just under half of all money spent on HIV programmes for this population from 2016 to 2018.
- While Eastern and Southern Africa received the most funding for programmes aimed at gay and bisexual men, this group also represented the highest number of new HIV infections in 2018.
- Gay and bisexual men are the worst affected by the HIV epidemic in Latin America. But of the money spent on the region’s HIV response, only one in every 200 dollars goes to this group.
- The fastest-growing regional epidemic is in Eastern Europe and Central Asia, with gay and bisexual men making up one in every five new infections, but this group receives only 1% of HIV funding.
- Transgender people
- Funding for programmes aimed at addressing issues transgender people face only received 0.06% of total HIV expenditure in lower- and middle-income countries between 2016 and 2018.
- While there is a need to increase resources targeting this population, it is hard to get a true sense of what is needed due to a lack of information — very few funders track investments on programmes for this group.
- The philanthropic community’s investment (41%) in programmes aimed at the transgender community was almost equal to that of the Global Fund (48%).
- Understanding funding availability and the number of HIV infections in different regions among this marginalised group is hindered by a lack of data.
- Transgender women accounted for 1 in every 50, or 2%, of new HIV infections in 2018 in Asia and the Pacific, but programmes aimed at transgender people only received 0.09% of all HIV funding.
- In the Caribbean, 1 in every 20, or 5%, of new HIV infections occurred in transgender women in 2018. But less than one in every 300 dollars, or 0,3%, spent on the region’s HIV response was allocated to transgender programmes.
- Sex workers
- Although HIV programmes targeting sex workers receive the most funding out of the key population groups, they only account for 0.6% of all HIV expenditure in lower- and middle-income countries.
- The largest amount of funding went to programmes in Eastern and Southern Africa from 2016 to 2018.
- Meanwhile, in Western and Central Africa this group made up 14% of all new HIV infections in 2018 but only received 1.5% of the total amount spent on the region’s HIV response.
- In 2018, one in every eight new HIV infections in the Middle East and Northern Africa were among sex workers. But only 1 in every 166 dollars was allocated for HIV programmes targeting this population.
- People who inject drugs
- Approximately 0.4% of all HIV funding went towards programmes aimed at people who inject drugs between 2016 and 2018 in lower- and middle-income countries.
- The growth and decline of funding for this population is largely dependent on the Global Fund, which accounts for nearly two-thirds of all funding for programmes targeted at this group.
- In 2018, two in every five new HIV infections in Eastern Europe and Central Asia were among people who inject drugs. There was also considerable funding targeting this group, with one in every 20 dollars of the region’s HIV expenditure going towards programmes aimed at this population.
- Some countries in this region have begun to use their national budgets to fund programmes aimed at this group instead of relying on donor funding.
- Although the Middle East and North Africa saw similar levels of infections to Eastern Europe and Central Asia, only 1% of money spent on their HIV response targeted people who inject drugs.
- A major challenge to receiving and allocating funding for programmes aimed at this population is punitive drug policies.
Aisha Abdool Karim was a senior health reporter at Bhekisisa from 2020 to 2022.
