The Human Immunodeficiency virus (HIV) is a virus that causes HIV infection and over time acquired immunodeficiency syndrome (AIDS). AIDS is a condition in humans in which progressive failure of the immune system allows life-threatening opportunistic infections and cancers to thrive. Without treatment, average survival time after infection with HIV is estimated to be 9 to 11 years, depending on the HIV subtype. In most cases, HIV is a sexually transmitted infection and occurs by contact with or transfer of blood, pre-ejaculate, semen, and vaginal fluids. Non-sexual transmission can occur from an infected mother to her infant through breast milk. An HIV-positive mother can transmit HIV to her baby both during pregnancy and childbirth due to exposure to her blood or vaginal fluid. Within these bodily fluids, HIV is present as both free virus particles and virus within infected immune cells.
HIV infects vital cells in the human immune system such as helper T cells (specifically CD4+ T cells), macrophages, and dendritic cells. HIV infection leads to low levels of CD4+ T cells through a number of mechanisms, including pyroptosis of abortively infected T cells, apoptosis of uninfected bystander cells, the direct viral killing of infected cells, and killing of infected CD4+ T cells by CD8+ cytotoxic lymphocytes that recognize infected cells. When CD4+ T cell numbers decline below a critical level, cell-mediated immunity is lost, and the body becomes progressively more susceptible to opportunistic infections, leading to the development of AIDS.
Awareness of HIV/ AIDS :
HIV awareness days have been designated in the United States, and are also observed in many other countries. They provide an opportunity to educate communities around the world about the importance of HIV prevention, research, HIV testing, and the issues for particular population groups. We use these opportunities to showcase the impact a preventive HIV vaccine could have on the global epidemic.
December 1: World AIDS day is an opportunity for people worldwide to unite in the fight against HIV, show their support for people living with HIV and to commemorate people who have died.
Domestic and International funding on HIV :
- To be on course to end AIDS as a public health threat by 2030, UNAIDS estimates that US$26.2 billion will be required for the global HIV response in 2020 alone. This means the world must increase the number of resources available for HIV by US$1.5 billion each year between 2016 and 2020, a situation that is looking increasingly unlikely.
- In recent years, high-income countries have reduced funding for the HIV response in low- and middle-income countries, with a 7% decrease reported between 2015 and 2016. Philanthropic donations, on the other hand, have risen for the past three consecutive years.
- Domestic funding for the HIV response now exceeded funds provided by international donors, accounting for 57% of the global funding total in 2015. In the face of donor stagnation, there is increasing emphasis on countries most affected by HIV to finance their own responses and find more efficient and cost-effective ways to do so.
- Despite the fact that between 40% and 50% of all new HIV infections among adults occur among key populations and their partners, just 2% of all HIV funding, and around 9% of resources allocated specifically for prevention are spent on these groups.
The huge mobilisation of resources for the global HIV and AIDS response over the course of the epidemic has been unprecedented in the history of public health. The challenge of funding HIV treatment, prevention and care in middle- and low-income countries have been characterised by vocal advocacy, unique and innovative funding mechanisms, previously unseen levels of bilateral (direct government-to-country) aid, and philanthropic donations whose scale have rivalled those of donor governments and multilateral institutions.
However, recent years have seen a regression. Donor funding for the HIV response in low- and middle-income countries declined by 7% between 2015 and 2016. This continuing trend of disinvestment towards the global HIV response follows several years of flat-line funding since the economic crisis hit in 2008 and global aid budgets began to constrain.
National governments in some low- and middle-income countries are now stepping up to fund their own responses, slowly filling some funding gaps and working towards a more sustainable response to HIV.
In 2011, the United Nations’ Political Declaration on HIV and AIDS called on the international community to mobilize between US$22 billion and US$24 billion for the global HIV response in low- and middle-income countries by 2015. At the same time, the 2011 UNAIDS Strategic Investment Framework encouraged countries to prioritize their spending on population groups most affected by HIV in order for funding to have the highest, most efficient impact. However, a lack of investment in key population programs remains a persistent issue.
The funding target set by the United Nations in 2011 was missed, with US$19.1 billion made available for the HIV response in low- and middle-income countries by the end of 2016. Domestic spending constituted 57% of these resources.
Since then, UNAIDS’ ambitious Fast-Track approach —endorsed by the UN General Assembly in the 2016 Political Declaration on Ending AIDS—has committed to ending the global HIV epidemic as a public health threat by 2030. In order to achieve this, UNAIDS estimates that US$26.2 billion will be required for the HIV response in 2020, steadily decreasing to $23.9 billion by 2030.
In order to reach the 2020 target, the world must increase the number of resources available for the HIV response by US$1.5 billion each year between 2016 and 2020. As a result, there is a lot more emphasis on countries most affected by the HIV epidemic to finance their own responses and find more efficient and cost-effective ways to do so.
Despite these rising financial commitments, the future outlook of global funding for the HIV response remains uncertain. In 2018, the United States of America (USA), the largest contributor to the global response, proposed cuts of US$1 billion.
Domestic resources :
Domestic funding is HIV spending, by country governments in their national budgets. Historically, the HIV response has been largely funded by international donors and governments, but low- and middle-income countries are now beginning to lead on efforts to finance their HIV response.
Historically, the HIV response has been largely funded by international donors and governments, but low- and middle-income countries are now beginning to lead on efforts to finance their HIV response.
In 2015, domestic resources exceeded funds provided by donors and accounted for the majority of global HIV funding (57%), totalling US$10.9 billion. Although domestic investments increased by an average of 11% a year from 2006 to 2016, the rate of that increase slowed to 5% between 2015 and 2016.
Although challenging for low- and middle-income countries, shifting towards domestic funding has advantages. These include fostering ownership and accountability in the implementation of the national HIV response and increase their sustainability.
Some wealthier countries are progressively contributing more domestic resources to the HIV response. For example, India funds more than 80% of its national HIV programs, while South Africa, pays for 77% of its response. However, the funding situation in South Africa is expected to become more challenging over the coming years following the government’s commitment to fund lifelong treatment.
Despite this progress, many low- and middle- income countries remain heavily dependent upon international donors to finance their HIV response. In 2014, 44 countries had 75% or more of their HIV financing needs provided by external sources. In East and Southern Africa, the region worse affected by HIV in the world, eight of the 15 countries reporting data to UNAIDS in 2017 were dependent on donors for more than 80% of their HIV response.
International funding :
International HIV funding from donor governments is provided through both bilateral and multilateral channels. International investment in the HIV responses of these countries peaked in 2013 at nearly US$10 billion; it has since declined to around US$8.1 billion in 2016.
This decline was due to a number of factors including the depreciation of donor currencies, delays in funding from the USA (the biggest donor), and the decision taken by many to ‘front-load’ their contributions to the Global Fund – so that they give earlier on.
The USA accounted for the majority of bilateral and multilateral funding from donor governments in 2016 (US$4.9 billion). Contributions by the USA were followed by the United Kingdom (UK) (US$645.6 million), France (US$242.4 million), the Netherlands (US$214.2 million) and Germany (US$182 million). Since 2006, these five countries have accounted for roughly 80% of all HIV funding from donor governments.
How is international HIV and AIDS funding allocated :
International HIV and AIDS funding is allocated in a number of ways and has changed over time. In recent years, funders of the HIV response have been exploring ways to increase the impact and efficiency of HIV and AIDS programs with many starting to aim resources at populations most at risk of HIV.
How does the Global Fund allocate its resources?
Between 2002 and 2011, the Global Fund allocated its HIV and AIDS resources on the basis of demand and country requests and disbursed its resources on a first come, first served basis. Under this system, the most ambitious proposals tended to receive grants regardless of the effectiveness of the chosen intervention, its cost-effectiveness or efficiency.
From 2012 to 2016, the Global Fund based on the distribution of HIV funds on country need and more specific objectives to control the epidemic. The allocation methodology was based on criteria such as HIV prevalence and a recipient country’s ability to finance its own response.
In April 2016, the Global Fund approved a new allocation methodology for 2017 to 2019. The new method gives greater priority to low-income/high burden countries. However, while low-income countries will receive 44.3% of Global Fund investment over this period, compared to 41.9% between 2014 and 2016, lower-middle income countries and upper-middle income countries will receive slightly less.
Once a country reaches upper-middle-income status, it is no longer eligible for Global Fund grants unless its disease burden continues to be classified as high. These countries will go through a process known as ‘transitional funding’, as they shift from Global Fund grants toward full domestic funding for health programmes. Between 2017 and 2019, 18 disease programmes from 14 countries will go through a transition.
Concerns have been raised regarding the effect transition may have on the HIV response. The Global Fund Advocates’ Network argues that using a country’s income level as a measure of its ability to sustain a public health response does not factor in that country’s willingness and ability to absorb programmes into its domestic funding and operational structures. Additionally, while many governments have shown a strong willingness to fund HIV treatment, very few have stated their commitment to continuing and expanding community-based prevention programmes aimed at key populations, the people who are most affected by HIV.
How could funding be spent more effectively?
While funding for the HIV response has generally increased over time, the rapid increase in spending on HIV treatment – in the era of ‘treatment as prevention’ – has led to a decline in funding for other prevention services. In recent years, spending on these prevention services has been reduced to about 20% of all HIV spending. The 2016 Political Declaration on HIV and AIDS saw member states committing to spend 25% of all spending on prevention, highlighting the current gap in funding for this area of the HIV response.
Just 2% of all HIV funding is spent on key populations, despite the fact that between 40% and 50% of all new HIV infections in adults occur among these groups.
Increasing funding for interventions aimed at key populations could also improve the efficiency of HIV financing. Currently just 2% of all HIV funding, and around 9% of resources allocated specifically for prevention, are spent on these groups, despite the fact that between 40% and 50% of all new HIV infections in adults occur among key populations and their partners. As mentioned above, the majority of funding for key populations comes from international donors. While these efforts help to fill the funding gap, they do not address the need for sustainable interventions driven by the domestic resources of affected countries.
Human rights work plays a vital role in protecting populations most affected by HIV. However, only US$137 million is spent annually on the global human rights response to HIV, accounting for just 0.13% of all HIV spending in low- and middle-income countries.75 Funding for harm reduction programmes that target drug users also remains far below estimated need and is in decline, dropping 7% between 2015 and 2016.
In 2016, overall funding for HIV prevention research and development decreased by 3% (US$35 million) from the previous year, falling to US$1.17 billion, the lowest level in ten years.
The future of funding for the HIV response
UNAIDS’ Fast-Track approach requires a rapid increase in funding for HIV over the next few years to have a decisive impact on the epidemic and ensure the long-term sustainability of the HIV response.
A number of factors have influenced the estimated funding needed. These include the 2015 World Health Organization treatment guidelines, which recommend all people living with HIV start treatment regardless of the CD4 count.
The stagnation of donor funding is also demanding that interventions are cost-effective and efficient. In 2012, the African Union (AU) endorsed the ‘Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria in Africa’, which emphasises country ownership, efficiency and sustainable financing of the HIV response and reflects increasing political commitment to these principals. An evolution of the Roadmap has since been endorsed by the AU in the 2013 Abuja + 12 Declaration, and again in 2015. Likewise, the ‘Arab Strategic Framework for the Response to HIV and AIDS (2014–2020)’ aims to increase reliance on domestic sources for the HIV response in all Arab countries by 80% by 2020.
Despite these commitments, and numerous low – and middle-income countries deploying a range of strategies to increase the efficiency and sustainability of their HIV and AIDS programmes, it is unlikely many, particularly low-income countries, will be able to shoulder the financial burden for tackling the HIV epidemic in the near future. For example, in April 2001 the AU pledged to allocate at least 15% of their annual budget to the health sector. In 2016, only four countries—Ethiopia, The Gambia, Malawi, and Swaziland—had met this target. This signals that current funding gaps will remain, and may increase in future years.
Source:– https://www.avert.org
Ajit Katte's 
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