Funding for key populations affected by HIV and AIDS “way off track”... This is one of the main conclusions from the first ever study into global funding for key populations, released today at the HIV2020 conference by Aidsfonds through the Bridging the Gaps and PITCH partnerships. Download your version today.
Funding for key populations affected by HIV and AIDS “way off track” with only 2% of money for HIV programmes targeting them. This is especially alarming as key populations and their partners account for more than half of all the new HIV infections globally.
This study was commissioned by Aidsfonds through the Bridging the Gaps and PITCH partnerships.
The research looks into the funding towards HIV programming for gay and bisexual men and other men who have sex with men, transgender people, sex workers and people who inject drugs in low and middle income countries between 2016-2018, and compares this against funding for the overall HIV response.
Executive summary
In 2016, global community agreed to work together to end AIDS by 2030. United Nations Member States backed UNAIDS’ Fast-Track strategy to realise this vision. Key populations, such as gay and bisexual men and other men who have sex with men, transgender people, sex workers and people who inject drugs, were recognised as being central to achieving this ambitious goal. These marginalised communities continue to bear the brunt of the epidemic, prevented from seeking HIV services by stigma and criminalisation.
To end AIDS by 2030 there needs to be a rapid scale-up of funding for effective HIV programmes for key populations
To address this and ensure an effective HIV response, World Health Organization (WHO) guidance stipulated that key populations should either lead, or be meaningfully engaged in, programmes targeting their communities. Yet, three years into the strategy, funding for HIV programming for key populations is way off track. To end AIDS by 2030 there needs to be a rapid scale-up of funding for effective HIV programmes for key populations.
This report highlights the resource gaps in HIV programming for these communities and compares this to funding for the overall HIV response. The analysis is informed by documented spending on HIV programming for key populations in low and middle-income countries (LMICs) between 2016 and 2018. It was commissioned by Aidsfonds and supported by key population partnerships Bridging the Gaps and PITCH.
Key populations (and their partners) account for the majority of new infections
Globally, the total number of new HIV infections has hardly declined for several years, stagnant at 1.7 million in 2018. This is far above the Fast-Track target of 500,000 per year by 2020 and reflects a worsening picture for key populations. In 2018, for the first time, key populations and their partners accounted for the majority (54%) of all new infections worldwide. In Eastern Europe and Central Asia, and the Middle East and North Africa, regions where the epidemic is expanding, key populations accounted for almost all new infections (more than 95% of the total).
Now even more important to target resources
The COVID-19 pandemic has exacerbated the situation; more than ever HIV resources must be targeted where they are most needed. COVID-19 undermines health for the most vulnerable and marginalised people now and, through economic, social and political pressures, in the future. The epidemiological data on HIV demonstrates that in every region of the world, the resources needed most are those that adequately fund HIV programming for key populations.
Only 2% of funding for HIV programmes targets key populations
Between 2016 and 2018, total combined resources for the HIV response in LMICs was approximately $57.3 billion. In the same period, the total funding of HIV programmes for key populations in LMICs is estimated at around US$1.3 billion. So, during the first three years of the Fast-Track approach, programmes targeting key populations received only 2% of all HIV funding, even though key populations accounted for over half of all new infections in 2018. The figure for total HIV funding above includes HIV treatment. The available data that informs this report does not disaggregate funding for HIV treatment programmes by key populations, so it is likely that some of the funding for HIV treatment in LMICs was in fact directed to key populations
Programmes targeting key populations received only 2% of all HIV funding, even though key populations accounted for over half of all new infections
However, disaggregated data does exist for HIV prevention programmes, and it still points to a huge disparity. Funding for all HIV prevention programmes in LMICs was estimated at $11.5 billion between 2016 and 2018; funding for all HIV programmes for key populations was $1.3 billion. The gap between those two numbers makes it clear that HIV programmes for key populations are still disproportionately under resourced.
Resource gap for HIV programmes for key populations is 80%
The resource gap for HIV programming for key populations was much bigger than the funding gap for the overall HIV response in LMICs. In 2016 UNAIDS estimated that $6.3 billion was necessary for the delivery of comprehensive service packages for key populations between 2016 and 2018. Another $551 million was required for the distribution of pre-exposure prophylaxis (PrEP) to these communities, making a total of $6.8 billion needed. So, there was a staggering gap of 80% between the budget required for HIV programmes targeting key populations ($6.8 billion) and the amount made available ($1.3 billion).