Financing our AIDS Response: Letter from Michel Sidibé, UNAIDS Executive Director

[In response to this recent blog from Health GAP's Matthew Kavanagh.]

Dear Matthew,

Thanks for your continued engagement.  Earlier this week I wrote to all of our UNAIDS country directors with some key points on the AIDS response that I also want to share with you.  I hope this helps clarify exactly where UNAIDS stands on the resources needed to end the AIDS epidemic as a public health threat in all populations: 

Today there is an immediate need for increased financing to tackle the epidemic. Today, millions of people are not able to access services, resulting in unnecessary death and disability.  Tens of millions do not know their HIV status.  We face a looming treatment crisis.  Increased investment is a critical part of the solution.

Shared responsibility and global solidarity have been at the center of the AIDS response from the beginning and those principles remain essential. The new UNAIDS financing report identifies a global need of US$ 26.2 billion in annual investment by 2020.  The document provides an example of how stakeholders can come together to reach this funding goal, but this scenario is meant as an illustration, not a prescription for how stakeholders achieve the funding necessary.  Financing the AIDS response is a dynamic process that we must track over time to ensure that the required amounts are mobilized and generate accelerated scale up of services for those in need.  The essential truth is we need increased resources from the global community to deliver the benefits of science to everyone.

Driving down HIV incidence and mortality will require substantial increased investments from both donors and implementing countries.  Donors can do more, and all implementing countries can as well. UNAIDS will continue to push for increased international investments for AIDS in the fast track period and develop strategies to bridge any frontloading gap that may occur.  Our primary goal is fully funding the AIDS response in the fast-track period and beyond.  We must not abandon any person or group, wherever they live.  Reaching those most affected must be the hallmark of our approach, and this means global resources to ensure key populations benefit from significantly scaled up services, in all countries.

In the UNAIDS Fast Track approach we have identified the gap in the provision of treatment and prevention services.  As part of these estimates we project that services specifically tailored for key populations need to reach around 13 million female sex workers, 7.5 million people who inject drugs, more than 1 million transgender women and approximately 16 million MSM by 2020 which corresponds to the 90% targets for preventive and outreach services for these populations.  All countries, including those in the middle-income category can and must do more to reach their populations most affected. In many such countries, it is evident that domestic resources are seldom available for reaching key populations, in spite of overwhelming evidence of the high burden and risk faced by them. The global community therefore must not allow these populations to be left behind. Investments for key populations must be increased and protected, and innovative funding streams made available wherever there are gaps.

A desk review of countries’ fiscal space indicates that if upper-middle-income countries maintain in the coming years their health shares of total government expenditure, and within that, the share for HIV, they could considerably increase their investment in addressing AIDS. Many countries are doing more. Domestic investment, which nearly tripled from 2006 to 2014, now accounts for nearly 60% of all resources for HIV in low- and middle-income countries.  However we also recognize that many upper and lower middle income countries with high HIV burden, irrespective of their income classification, will need to continue to receive international assistance to meet the urgent scale up needs of HIV treatment and prevention services.

Communities have always been central to the AIDS response.  The recent UNAIDS Fast Track financing report calls for significantly increased investments in community based services and community mobilization, and additional funding to address the social and legal context, including fulfilling human rights, that affect people’s ability to access services and protect themselves. 

UNAIDS stands with everyone affected by AIDS, including key populations and all those left behind.  As the world comes together for the High Level Meeting on AIDS in June, UNAIDS will continue to speak to the need to marshal the financing necessary to address vulnerabilities and decrease new infections, save lives and, one day, make the AIDS epidemic a thing of the past, leaving no one behind.

I look forward to your continued advocacy in support of our common goals.

With all my very best, and see you soon in New York, 


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