More than three decades into the fight against HIV/AIDS, a growing sense of complacency and fatigue threatens to derail the momentum needed to accelerate the world’s collective efforts. The notion of AIDS as an urgent issue of concern has faded from news headlines and the hallways of governments, leaving many to believe that the disease has been tackled or that the world has moved on. Yet, of course, this notion could not be further from reality.
The Challenge
Globally, 1.9 million people were newly added to antiretroviral treatment last year – increasing the total number of people on treatment to 14.9 million by the end of 2014– but 2 million people became newly infected with HIV in the same year, outpacing the growth in access to treatment.
Marginalized populations around the world are increasingly at risk for HIV infection. Compared with the general population, men who have sex, transgender women, and people who inject drugs are dramatically more likely to be living with HIV. Adolescent girls and young women are also vulnerable; in sub-Saharan Africa, they are almost three times as likely as their male peers to be living with HIV.
Worryingly, spending on the disease has plateaued, raising $20.2 billion from all sources in 2014, down slightly from 2013’s historic high of $20.4 billion. External funding for AIDS continues to be concentrated among just a few donors, with only five countries (the US, the UK, France, Germany and the Netherlands) contributing 87% of funds. Meanwhile, private philanthropic spending on AIDS was at its lowest level since 2007, and only six African countries (Rwanda, Swaziland, Ethiopia, Malawi, the Central African Republic and Togo) met their Abuja commitments to spend 15% of their national budgets on health, leaving billions in potential domestic resources for health unspent.
The Opportunity
Experts argue that we are now in a unique window of time: if we can aggressively scale up our investments and programs in the next five years, we could bend the curve of the disease towards its ultimate end as an epidemic by 2030. Conversely, if services remain at 2013 levels, the epidemic could outpace response measures and rebound by 2030. In order to put the world on a trajectory towards defeating AIDS, UNAIDS estimates that low- and middle-income countries will require nearly $32 billion annually by 2020—roughly $12 billion more than is currently spent.
The Way Forward
World leaders must urgently begin to act, stepping forward to deliver more resources from more sources, spent more effectively and accountably, and targeted at the right people. In 2016, world leaders will have prime opportunities to make new down-payments on this agenda. In particular, the Global Fund’s Fifth Replenishment will offer donors, beneficiary countries and the private sector the chance to show that they are willing to invest in turning the tide against HIV/AIDS and other infectious diseases. A High-Level UN Special Session on AIDS and the International AIDS Conference in Durban, South Africa in mid-2016 will also provide platforms for policy-makers, advocates and scientists to take stock of progress made, to highlight remaining gaps and to renew collective commitments to ending this disease. At each of these moments, the world will be watching, eager to see whether rhetoric turns into reality for the fight against AIDS and for the millions of people whose fates hang in the balance.
More information
- ONE’s full-length 2015 report, including in-depth analysis of top donor and African health spending levels
Written by Erin Hohlfelder for the GHP newsletter.
Erin Hohlfelder
Policy Director, Global Health
ONE
Photo: CDC Global - https://www.flickr.com/photos/cdcglobal/22873418413/