It can be no coincidence that such countries are largely middle income countries. The majority of people living with HIV now live in middle income countries where development assistance is largely being reduced.
More and more countries are making the transition to middle income but poverty and inequality remain, particularly when it comes to marginalised and vulnerable groups. For the first time last year domestic funding surpassed the contributions of international donors and governments are taking on greater financial responsibility for their national health and HIV responses. But to really break the back of the epidemic once and for all, investment choices need to be made based on where they will have the most impact and deliver the greatest value for money.
According to UNAIDS, in 49 countries with available data HIV prevalence was 22 times higher in people who use drugs than in the general population but 92% of spending on HIV programmes for people who inject drugs comes from international donors. Available data on funding for programmes for other marginalised groups at most risk of the epidemic such as sex workers and men who have sex with men (and we would add transgender people) reveals a similar woeful tale and raises serious sustainability concerns going forward.
The report makes the point that there is insufficient leadership in response to AIDS among people who inject drugs and how there needs to be increased national ownership of prevention programmes, especially in middle income countries. From an Alliance perspective, the importance of communities as equal partners in an effective HIV response is critical if we are to ensure universal access to services for all marginalised groups. UNAIDS data indicates that female sex workers are 13.5 times more likely to be living with HIV than are other women and that the prevalence of HIV infection among men who have sex with men in capital cities is on average 13 times higher than that in the country’s general population.
The report also highlights how efforts to accelerate progress towards eliminating gender inequalities and gender-based abuse and violence continue to be undermined by inadequate resources for initiatives to address the epidemic’s gender dimensions.
Alvaro Bermejo, the Executive Director of the International HIV/AIDS Alliance said: “The changing face of the HIV epidemic in recent years means that there is more need than ever to ensure that funding is directed at the right programmes for the right populations at the right scale. Strategic decisions need to be made that will have the greatest impact and reach the poorest and most marginalised wherever they live.
“Politically isolated groups are currently bearing the brunt of the epidemic and we risk seeing a major roll back on achievements if we fail to address the human rights issues and abuses that are impeding a truly effective global HIV response.”
You can download a copy of the report and read UNAIDS’ press release here.
Click here to read our statement in Spanish.