Tracking development assistance for HIV/AIDS: the international response to a global epidemic

As the HIV/AIDS pandemic spread throughout the 1980s and 1990s, prevalence was concentrated in many low and middle-income countries [1]. In these countries, there were relatively few resources available to effectively counter the spread [2,3]. Between 1990 and 2000, the number of people living with HIV or acquired immunodeficiency syndrome (HIV/AIDS) in low and middle-income countries nearly tripled [2]. During this same period, the number of deaths caused by AIDS in those same countries more than quadrupled. The rapid evolution of the epidemic and the concentration in poor countries propelled HIV/AIDS high on the global development agenda. Enshrined in Millennium Development Goal (MDG) 6, HIV/AIDS was identified as one of the top health priorities at the United Nations Millennium Summit in 2000 [4]. Shortly thereafter, many key international donors increased funding for the expansion or genesis of several major international organizations focusing specifically on combating HIV/AIDS. The US President's Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund) and the Joint United Nations Program on HIV/AIDS (UNAIDS) stand as three major organizations that expanded or were created. Despite the focus on preventing and treating HIV/AIDS, little is known about the international resources funding these efforts. The major sources of HIV/AIDS resource tracking, including the National AIDS Spending Assessments and the new System of Health Accounts, provide valuable information about financing flows, but are limited by challenges revolving around timeliness, level of reporting, and comparability [5–7]. To better understand international funding for HIV/AIDS, this study sets out to systematically track development assistance from all major international development agencies and split this spending into nine program areas that describe how the resources were used. This research highlights the changing priorities and investments of the international community over the last 26 years.