1. 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

2. 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

3. 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

4. Resources for HIV in 2015 by source of funding

5. Global Resources for HIV/AIDS in Low-and-Middle-Income Countries , by source (Excluding countries which were classified as high income level by )
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

6. 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.

7. International HIV Assistance from Donor Governments: Percent Difference in Disbursements (USD),
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.

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

9. 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): e doi: /journal.pone

10. 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 compared to 2010

11. 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:
$ per additional dollar spent (higher for UMICs)
Range depend on Efficiencies on the business as usual

12. 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): e doi: /journal.pone

13. 2015 Resource availability and estimated resource needs 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.

14. “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

15. 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%

16. 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.

17. 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

18. 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

19. 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

20. 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