So Close, Yet So Far: Why is HIV/AIDS Funding Decreasing?

December 1, the 30th anniversary of the first World AIDS Day, offered a moment take stock of the ongoing battle against an epidemic that’s killed 35 million people since the 1980s.

The good news is that antiretroviral therapy has transformed HIV from a nearly always fatal infection into a manageable chronic condition. The bad news is that despite the effectiveness of medication, HIV remains a global health threat, claiming nearly a million lives last year, while another 37 million people are living with the virus. What’s more, philanthropic funding for research, treatment, prevention and awareness around HIV/AIDS is decreasing.

According to the latest data by Funders Concerned About AIDS (FCAA), such giving decreased by 5 percent, or $37 million, between 2016 and 2017—reaching the lowest level since 2014. A significant portion of the decreases came from the top 20 funders, who accounted for 88 percent of HIV-related philanthropy in 2017.

Private giving for this cause has decreased even as the world’s wealthiest people have grown richer. According to Forbes, the 2,208 billionaires around the globe had a combined net worth of $9.1 billion in March 2018—up 18 percent from a year earlier.

Still, the dip in HIV/AIDS funding came as no surprise to the folks at FCAA. “For the past two years, we have cautioned that the increases we were seeing in philanthropic funding were concentrated among just a few funders. At the same time, a growing number of others were decreasing resources to fight the epidemic,” said Channing Wickham, executive director of the Washington AIDS Partnership and chair of FCAA’s board of directors. “The 2017 data show that our concerns have been made a reality.”

Who’s Giving?

A total of 427 philanthropic funders in 14 countries made more than 6,700 grants for HIV/AIDS to approximately 3,400 grantees totaling $638 million in 2017.

The Bill & Melinda Gates Foundation led the way, with $447.6 million in funding, followed by Gilead Sciences ($155.4 million), ViiV Healthcare ($37.6 million), MAC AIDS Fund ($23.2 million), and the Elton John AIDS Foundation ($19.7 million).

Corporate funders have continued to play an important role in the response, with support that represented 36 percent ($242 million) of total HIV-related philanthropy for the year. Also notable is the role of those funders that focus specifically on HIV, which accounted for roughly a quarter of total funding last year ($144 million).

Where Did the Money Go and How is it Being Spent?

Historically, most HIV/AIDS funding has been global, with many grant dollars flowing to help countries where the crisis has hit hardest, including Kenya, South Africa, Zimbabwe and Zambia. But this year’s FCAA report finds that such international funding has declined, and spotlights serious imbalances in how resources are distributed.

Low and middle-income countries (where 60 percent of HIV positive people reside), only received 28 percent of country-specific HIV-related philanthropy in 2017, a 21 percent decrease from 2016. According to the Stop AIDS Alliance, by 2020, 70 percent of people living with HIV will likely be in low and middle-income countries.

As for how funding is used, as always, research was the clear front runner in 2017 ($210 million), followed by prevention ($169 million), and treatment ($142 million). Advocacy and human rights was another major focus of funders ($115 million).

Although HIV/AIDS funding decreased overall, some target populations got more attention from funders in 2017—most notably, funding for transgender populations grew by 110 percent.

Funding in the U.S.

While support to low and middle income countries declined in 2017, HIV/AIDS funding to the U.S. reached a new high, totaling $186 million, a 7 percent increase from 2016. In particular, funding targeted at African Americans and Latinos saw big increases.

Much of this rise in U.S. funding came from Gilead Sciences, which poured new resources into combating HIV/AIDs in the American South. As we’ve reported, this funding is significant, given that the South accounted for more than half of the new HIV infections in the U.S. in 2016.

Gilead has been a leader in testing, treatment and prevention of HIV for nearly three decades. Worldwide, it's the second-largest funder of HIV/AIDS programs after the Bill and Melinda Gates Foundation. Gileads’ COMPASS (COMmitment to Partnership in Addressing HIV/AIDS in Southern States) Initiative, is a 10-year, $100 million commitment to support organizations working to address the HIV/AIDS epidemic in the Southern United States.

Beyond Gilead Science, the largest funder focused in the region is the Southern HIV Impact Fund, a much newer player. The fund, which was established in 2016 and is managed by AIDS United, consists of a group of partners brought together by Funders Concerned About AIDS and includes Gilead Sciences, Ford Foundation, the Elton John AIDS Foundation, ViiV Healthcare, and Johnson & Johnson. In 2017, it made an investment of $2.65 million in support of 37 grantee organizations in nine deeply impacted states: Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee and Texas.

While the new focus on the South is encouraging, there are still major gaps in funding. In the U.S., HIV is rising fastest among people who inject drugs—especially injectable opioids. However, only 3 percent of HIV-related philanthropic dollars was directed to that population, down 11 percent from 2016. Similarly, sex workers are 13 times more likely to contract HIV than members of the general population, but received only 2 percent of HIV-related philanthropic dollars, a year-over-over decrease of 24 percent.

What’s Next?

More private funding is needed to expand treatment for the 37 million people living with HIV, reduce the death toll from AIDS, and cut new infections. Unfortunately, trends are running in the exact opposite direction. Instead of stepping on the gas, philanthropy is seemingly putting on the brakes.

Why is that? Donor fatigue is one likely reason, given that this global health crisis has been going on for decades. But another problem is that HIV/AIDS is rarely portrayed as the deadly epidemic and global health crisis it still is. Ironically, the fact that medications have made it a more manageable condition has reduced the sense of urgency around HIV/AIDS. While it may be easier than ever for donors to save lives, they’re seemingly less interested.

Still, it’s important to look on the bright side. A strength of philanthropy is the ability to stick with important work over the long haul, even when the public and media lose interest. And to their credit, top funders like Gates and Gilead remain stalwart in their commitment to fighting HIV worldwide. Philanthropy can also take risks and experiment with different approaches to entrenched problems, and we continue to see funders opening new fronts in the battle against HIV/AIDS, such as the increased focus on transgender populations and the American South.

“Private HIV and AIDS philanthropy is catalytic. It has helped drive incredible progress against the epidemic despite seemingly insurmountable odds, not unlike those we now face,” said John Barnes, FCAA’s executive director. “It is the role of philanthropy to swim upstream, to fight prevailing headwinds that challenge progress and to leverage a unique ability to drive increased, focused funding where it is most needed.”