Long-Term Analysis Highlights Half Trillion Dollars Spent on HIV/AIDS

Global funding for HIV/AIDS topped more than half a trillion dollars between 2000 and 2015, according to the first long-term, comprehensive analysis of funding for the disease.¹

Researchers tracked health spending on HIV/AIDS for 188 countries during the 16-year period. They estimated spending measures by financing source—government spending, out-of-pocket (OOP), and prepaid private spending—as well as 3 HIV/AIDS spending categories: prevention, care and treatment, and all other spending. Data were extracted from the AIDSinfo database; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; National Health Accounts that capture HIV/AIDS spending; all National AIDS Spending Assessments; and Asia-Pacific region data from the AIDS data hub.

Over the 16-year period, $562.6 billion was spent on HIV/AIDS. The spending peaked in 2013 with $49.7 billion. Although there was a slight decrease to $48.9 billion in 2015, spending that year was nearly 3 times that of spending in 2000 ($16.4 billion).

Despite the majority of people with HIV/AIDS living in middle-income and low-income countries, most of the spending occurred in high-income and upper-income countries. In 2015, high-income countries spent $16.3 billion on HIV/AIDS, and upper—middle-income countries spent $14.7 billion. While spending continued to grow between 2013 and 2015 in these countries, spending decreased among lower–middle-income and low-income countries during the same period. In 2015, $9.8 billion was spent in lower–middle-income countries, and $8 billion was spent in low-income countries.

Governments played a key role in spending, contributing a total of 61% ($29.8 billion) of all HIV/AIDS spending in 2015. Meanwhile, OOP spending accounted for less than 10%, underscoring the importance of international and domestic government efforts in funding for the disease.

Development assistance for health, funding from high-income countries to support efforts in lower-income countries, accounted for 30% of all HIV/AIDS spending in 2015. “Reliance on development assistance to fight HIV/AIDS in high-prevalence countries leaves them susceptible to fluctuations in external resources available for HIV/AIDS,” said Joseph Dieleman, MD, Institute for Health Metrics and Evaluation, lead author of the study, in a statement.

Spending on care and treatment of HIV/AIDS has seen significant growth since 2000. In 2000, $8.1 billion was dedicated to care and treatment services, including inpatient and outpatient care and antiretroviral care administered in those settings. By 2015, $27.3 billion was spent on these services. Prevention resources, such as general public health programs, accounted for $4.0 billion in 2000 and climbed to $9.3 billion in 2015.

The analysis also showed that, in 2015, countries with a low prevalence (less than 1%) of the disease spent the most ($31.9 billion) on HIV/AIDS and had the highest spending per prevalent case. In contrast, countries with a high prevalence (1%-5%) and countries with an extremely high prevalence (more than 5%) spent $8.8 billion.

“This research is an initial first step toward global disease-specific resource tracking, which makes new, policy-relevant analyses possible, including understanding the drivers of health spending growth,” said Christopher Murray, MD, director, Institute for Health Metrics and Evaluation, University of Washington, in a statement. “We are quantifying spending gaps and evaluating the impact of expenditures.”

Reference

1. Global Burden of Disease Health Financing Collaborator Network. Spending on health and HIV/AIDS: domestic health spending and development assistance in 188 countries, 1995—2015 [published April 17, 2018]. Lancet. doi: 10.1016/S0140-6736(18)30698-6.