In the Face of Uncertainty: Philanthropy’s Role in Funding HIV/AIDS Fight is More Critical than Ever
Over the years, philanthropic resources have grown dramatically, becoming an integral component to the global response to HIV and AIDS. Although the increase in philanthropic funding is encouraging, there is still much effort needed to ensure we have the resources necessary to meet global health targets.
The landscape for HIV/AIDS funding, flatlining for years, is, as of November 8, 2016, more uncertain than ever. With this uncertainty comes the fear of rolling back or even halting progress. Early indications from the new U.S. administration hint that funding for global healthcare programs will not be a top priority. In fact, some may argue that these resources, including funding for HIV/AIDS, are under direct attack.
The new administration has, for instance, questioned the value of the President’s Emergency Plan for AIDS Relief (PEFPAR). Due to its strategic investments and long-standing bipartisan support, PEPFAR is regarded as one of the most successful programs in global health. Eliminating PEPFAR, the largest global funder of HIV and AIDS efforts, would significantly hinder, if not make impossible, the world’s goal of ending the epidemic as a public health threat by 2030. Furthermore, with the recent Executive Order to reinstate the “Global Gag Rule”—which restricts international organizations receiving U.S. funding from performing or promoting abortion services — PEPFAR and other successful programs will face inevitable funding cuts.
While the U.S. government is the largest, it is certainly not the only funder of the global fight against HIV and AIDS. Enormous partnership and collaboration efforts have been key components to the success experienced to date in beating back the epidemic. In addition to bilateral and multilateral organizations, as well as national governments, private philanthropy has played an important role. Though philanthropic funding comprises only 2 percent of global resources, its contributions are critical. These are often the only resources, for example, allocated to advocacy, the biggest lever to help mobilize the fight.
Over the years, philanthropic resources have grown dramatically, becoming an integral component to the global response. What began with only five private foundation grants and $216,000 in 1983 has increased, most recently, to $663 million in 2015. In fact, Funders Concerned About AIDS’ (FCAA) new report, Philanthropic Support to Address HIV/AIDS in 2015, shows that HIV philanthropic funding in 2015 reached its highest point since 2008.
Although the increase in philanthropic funding is encouraging, there is still much effort needed to ensure we have the resources necessary to meet global HIV and AIDS targets. While overall philanthropy from U.S.-based foundations and corporations reached a new high of $78.3 billion, HIV/AIDS-specific work amounted to $558 million in 2015. Although this is a 10 percent increase from 2014, it indicates that, across all areas of philanthropy, AIDS continues to be a lower priority; just 71 cents of every $100 was allocated to issues related to the disease. In addition, these resources are concentrated among only a handful of donors, leaving the field vulnerable to the decisions and fluctuations of a relatively small group.
All this comes at a time when we are closer than ever to ending AIDS as a public health threat by 2030. But doing so requires us to identify the resources needed to meet key milestones within a short window of opportunity and with a sense of urgency. The good news is that there are critical action steps that funders can take immediately to protect the future of this fight:
- Look to the data. In such a precarious environment, we must be able to defend funding by making the strongest case possible. Without data, funders are not able to make informed decisions about where their resources would make the most difference. On the flip side, with the proper data in hand, funders can help ensure we remain on track in our efforts to meet the 2030 deadline. It is for precisely this reason that FCAA compiles our annual resource tracking report; to highlight the gaps in the response and help ensure each dollar that funders allocate has the greatest impact.
- Address the closely inter-related issues which often fuel the epidemic, such as health equity, racism, homophobia, poverty, and reproductive health and justice. National governments in implementing countries—and, indeed, many bilateral donors—are not likely to allocate resources in these areas for a multitude of reasons. For its part, FCAA is committed to identifying and analyzing HIV/AIDS-related philanthropy that addresses human rights ($123 million in 2015) and LGBTQ issues ($57 million in 2015) in partnership with colleagues at the International Human Rights Funders Group and Funders for LGBTQ Issues.
- Be prepared to step in where national governments will not. The Dutch government, for example, recently committed to create a new international abortion fund to help fill the catastrophic $600 million gap in services that may result from the reinstatement of the Global Gag rule. But philanthropy will also have an increased role to play in this effort if we are to make progress; among HIV-related philanthropy in 2015, only $19 million addressed global (non U.S. or Western and Central Europe) efforts related to family planning and reproductive health for women and youth, just 3 percent of the predicted funding gap.
- Don’t lose focus on middle-income countries. These countries are home to nearly 70 percent of the world’s people living with HIV. Yet FCAA’s report shows that HIV/AIDS-related private philanthropy totaled just $126 million (less than 20 percent) in 2015. At the same time, UNAIDS estimates that addressing the epidemic effectively in these countries requires well beyond the $19 billion allocated in 2015; $26.2 billion is needed by 2020 in order to be successful.
Private funders have the opportunity to help middle-income countries. In Brazil, where HIV infection rates have increased by 11 percent between 2005 and 2013 — soaring to 53 percent in youth 15-19 — private funders, including Gilead Sciences, have added resources to seed money provided by the Brazilian Health Ministry to form Fundo PositHIVo. Within its first year, Fundo PositHIVo made multiple grants related to advocacy, education and prevention efforts.
In these uncertain times, it is going to be crucial that we not only increase philanthropy for HIV/AIDS, but that we also track where valuable resources are going. We need to remain vigilant, protecting funding where we can, and fighting against restrictive legislation. We must also bring heightened awareness to funding gaps so that we can more effectively meet the needs of the most vulnerable.
Now, more than ever, we are calling on the private sector to increase their support for this global fight. Because, without philanthropy’s contributions, it is a fight we cannot win.