Resource Availability for HIV, 2015 Overview of the financing situation Jose-Antonio Izazola Innovative Approaches for Sustainable Financing of AIDS Responses: Finding the 26 billion by 2020 Thursday, July 21st , 2016

Source: UNAIDS Estimates June 2016, UNAIDS-KFF reports on Financing the Response to AIDS in Low- and Middle-Income Countries till 2015, OECD CRS last accessed June 2015, FCAA Report on Philanthropic funding Dec 2015

Resources for HIV ( 2000- 2015) by source of funding Source: UNAIDS Estimates June 2016, UNAIDS-KFF reports on Financing the Response to AIDS in Low- and Middle-Income Countries untill 2015, OECD CRS last accessed June 2015

Resources for HIV in 2015 by source of funding

Global Resources for HIV/AIDS in Low-and-Middle-Income Countries 2000-2015, by source (Excluding countries which were classified as high income level by 2013-4) Source: UNAIDS Estimates June 2016, UNAIDS-KFF reports on Financing the Response to AIDS in Low- and Middle-Income Countries until 2015, OECD CRS last accessed June 2016, FCAA Report on Philanthropic funding Dec 2015

International HIV Assistance from Donor Governments: Disbursements, 2002-2015 US$ Billions SOURCES: UNAIDS/Kaiser Family Foundation, Financing the Response to HIV in Low- and Middle-Income Countries: International Assistance from Donor Governments in 2015, July 2016; UNAIDS and Kaiser Family Foundation analysis of data from donor governments, OECD CRS online data queries, Global Fund to Fight AIDS, Tuberculosis and Malaria online data queries, and UNITAID Annual Reports and direct communication.

International HIV Assistance from Donor Governments: Percent Difference in Disbursements (USD), 2014-2015 SOURCES: UNAIDS/Kaiser Family Foundation, Financing the Response to HIV in Low- and Middle-Income Countries: International Assistance from Donor Governments in 2015, July 2016; UNAIDS and Kaiser Family Foundation analysis of data from donor governments, OECD CRS online data queries, Global Fund to Fight AIDS, Tuberculosis and Malaria online data queries, and UNITAID Annual Reports and direct communication.

Cumulative domestic Public Spending (US$ millions) by Income Level Source: UNAIDS estimates 2016

Resource needs 2016-2030 to Reach the “End of AIDS” as a global public health threat Source: Stover J, Bollinger L, Izazola JA, Loures L, DeLay P, Ghys PD, et al. (2016) What Is Required to End the AIDS Epidemic as a Public Health Threat by 2030? The Cost and Impact of the Fast-Track Approach. PLoS ONE 11(5): e0154893. doi:10.1371/journal.pone.0154893

Resource Needs to End AIDS as a global public health threat? “What is needed” approach Non-linear effect of frontloading and increasing resources Not just more money to have similarly more results Epidemic control by 2020 Infections averted earlier Number of new infections lower than AIDS related deaths “End of AIDS” as a global public health threat by 2030 To reduce incidence and mortality by 90% in 2030 --compared to 2010

Resource Needs to End AIDS as a global public health threat? Embedded savings (~US$12 Bn by 2020) Increased efficiency (allocative, technical) Streamlined ART treatment modalities Right populations in the right places Increased programme effectiveness 75th percentile (instead of median) Affordable prices New ARVs Community based service delivery From current 5% to 30% Focused and increased prevention 25% of global total in average for FIVE Prevention Pillars ROI: $7.3-11.6 per additional dollar spent (higher for UMICs) Range depend on Efficiencies on the business as usual

Citation: Stover J, Bollinger L, Izazola JA, Loures L, DeLay P, Ghys PD, et al. (2016) What Is Required to End the AIDS Epidemic as a Public Health Threat by 2030? The Cost and Impact of the Fast-Track Approach. PLoS ONE 11(5): e0154893. doi:10.1371/journal.pone.0154893

2015 Resource availability and estimated resource needs 2016-2030 for Fast-Track approach to “End AIDS” as a global public health threat Source: UNAIDS Estimates June 2016, UNAIDS-KFF reports on Financing the Response to AIDS in Low- and Middle-Income Countries till 2015, OECD CRS last accessed June 2015, FCAA Report on Philanthropic funding Dec 2015, update to fast-track investments , UNAIDS April 2016.

“Fast Track” Countries by Income Level CAR LIC WCA Generalized Chad Congo DRC Ethiopia ESA Mali Concentrated South Sudan Tanzania Uganda Malawi Hyperendemic Mozambique Zimbabwe Pakistan LMIC AP Low Level Cameroon India Indonesia Myanmar Ukraine EECA Vietnam Ghana Ivory Coast Kenya Nigeria Lesotho Swaziland Zambia “Fast Track” countries account for 90% of annual HIV infections 33 are L&MICs China UMIC AP Low Level Brazil LAC Concentrated Mexico Thailand Angola ESA Generalized Botswana Hyperendemic Namibia South Africa

Resource Needs for all Fast Track Countries (M USD) and by Income Group as proportion of GDP Total resource needs: LICs= 2.1% of GDP; LMICs=0.8% ; UMICs=0.5%

Alternative scenario: Projections for potentially reducing the Domestic Financing Gap in Fast-Track Countries (M USD): targeted budgets, earmarked taxes and levies and efficiency savings.

Potential Domestic resource mobilization Countries could substantially increase their HIV domestic public investments through a mix of policies: Increased allocations to health in line with economic growth and within it increased investment to HIV in line with disease burden Innovative financing through modest earmarked taxes and levies Increased efficiency in public financial management, resource allocation and service delivery Highly concessional borrowing Some countries will still require international financing

Conclusions Domestic Public resources have steadily risen but not “high enough”; International plateauing or decreasing Resource needs: significant and require frontloading. 5-year window of opportunity Competing needs and opportunities Global Solidarity and Shared responsibility Principles Countries which can pay should do so to the extent of their capacity Countries which can not pay, should receive international support Cost of Inaction: Pay now or pay significantly higher in lives, health and money = No End of AIDS by 2030

Conclusions (2) Traditional domestic financing schemes are insufficient to meet the needs Need of sustained (and increasing) funding from international sources in addition to domestic Increased health allocations Focused HIV spending Earmarked levies and taxes Borrowing New financing mechanisms need: to be politically palatable, To take into account budgeting cycles (medium & long term) competing needs transition of countries

Alarms: New HIV infections in adults are not declining Funding is not sufficient to reach Fast Track or the End of AIDS by 2030 Not close to frontloading and increasing resources before 2020 If resources not available no sufficient infections averted, needs for ART increased Social, Health and financial costs will sharply increase