Donor Government Funding for HIV in Low- and Middle-Income Countries in 2023

Key Findings

This report provides an analysis of donor government funding to address the HIV response in low- and middle-income countries in 2023, the latest year available, as well as trends over time. It includes both bilateral funding from donors and their multilateral contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), UNITAID, and Joint United Nations Programme on HIV/AIDS (UNAIDS). Overall, the analysis shows that funding for HIV decreased between 2022 and 2023. While most of this was due to timing, the longer trend shows a shift away from bilateral funding by most donors, one that has not been fully offset by multilateral support. As a result, HIV funding, while fluctuating over time, has not returned to its highest level, reached a decade ago. At the same time, while there has been significant progress in addressing the HIV epidemic, the number of people newly infected by HIV is rising in some regions, some populations are particularly at risk and lack access to prevention services, and almost a quarter of people living with HIV are still not on treatment.¹ Key findings include the following:

• Donor government funding for HIV decreased in 2023 compared to the prior year. Disbursements were US$7.86 billion in 2023, a decrease of US$358 million compared to 2022 (US$8.22 billion), in current U.S. dollars (not adjusted for inflation).² Funding decreased even after accounting for exchange rate fluctuations. Looking more broadly, HIV funding in 2023 was essentially the same as in 2008 (US$7.78 billion), and well below the peak level reached in 2014 (US$8.60 billion). As a result, funding has not kept pace with inflation.³
• While both bilateral and multilateral funding in 2023 declined, most of the decline was in multilateral support. Bilateral funding declined slightly, by US$46 million, to US$5.58 billion in 2023 compared to US$5.62 billion in 2022. Multilateral funding declined by US$312 million, to US$2.28 billion in 2023 compared to US$2.59 billion in 2022.⁴
• The decline in multilateral funding, however, was largely due to the timing of donor government contributions to the Global Fund in 2023, reflecting pledging periods, not reductions in actual support. With 2023 marking the first year of the most recent pledge period (2023-2025), there were large fluctuations in contributions to the Global Fund from most donor governments when compared to 2022 totals. Some donors choose to “front-load” contributions (e.g., the U.K. fulfilled almost its entire pledge for 2023-2025 in 2023), while others choose to fulfill pledges towards the end of the pledge period (e.g., Denmark did not provide any contribution in 2023 and will likely be fulfilling its pledge in future years).⁵
• The US continued to be the largest donor to HIV. In 2023, the U.S. disbursed US$5.71 billion, accounting for 73% of total donor government HIV funding (bilateral and multilateral combined).⁶ The U.K. was the second largest donor (US$714 million, 9%), followed by France (US$320 million, 4%), Germany (US$228 million, 3%), and the Netherlands (US$187 million, 2%). When standardized by the size of economy, the U.K. ranked first, followed by the U.S., the Netherlands, Sweden, and France.
• More broadly, trends show that donor governments, other than the U.S., have significantly reduced their bilateral HIV support while increasing funding to the Global Fund, although this shift has not fully offset bilateral declines. Since 2011, the first year where detailed bilateral and multilateral data are available for all donors, bilateral funding from donor governments other than the U.S. has declined by US$1.37 billion (-80%). While multilateral funding from these donor governments has increased in recent years and was higher in 2023 (US$1.81 billion) than 2011 (US$1.46 billion), these increases have not been large enough to offset bilateral declines. Increases from the U.S. in some years have, for the most part, countered these declines.
• Looking ahead, increases in donor government funding for HIV in low- and middle-income countries seem uncertain at best. There are significant headwinds on the horizon that complicate the funding picture from donor governments. These include multiple geopolitical challenges and broader economic pressures, as well as a crowded global health replenishment schedule, with several global health institutions, including the Global Fund, seeking to raise funds from the same donors over the same time period. Finally, national elections have either recently concluded or are taking place in the coming months in several donor capitals, including the U.S., the outcomes of which could shape future funding for HIV.