The 69 low- and middle-income countries with available data spent a total of US$ 5.1 billion on the AIDS response in 2008. Out of the 69 countries, there are 32 low-income countries, 26 lower middle-income countries and 11 upper middle-income countries. Prevention amounted to US$ 1.1 (+/- 22 million) billion of this total (21%); however, the majority of spending was focused on treatment and care (53%). Table (Reported total and per capita prevention spending, proportion of international funding and overall HIV funding allocated to prevention by epidemic type for 69 countries, in order of per capita spending, 2008 (USD)) shows the absolute and per capita amounts spent on prevention by epidemic type, the level of financing coming from international sources, the proportion of overall HIV resources that were allocated to prevention and countries' ranking with respect to per capita spending.
Reported total and per capita prevention spending, proportion of international funding and overall HIV funding allocated to prevention by epidemic type for 69 countries, in order of per capita spending, 2008 (USD)
The study includes 15 countries with low-level epidemics, 28 with concentrated epidemics and 26 with generalized epidemics. Once adjusted by the size of their populations, countries with generalized epidemics showed higher average per capita spending on prevention-US$ 1.82 (Range .28-15.37) compared to US$ 0.68 (Range .10-2.28) in concentrated epidemics and US$ 0.29 (Range .01-1.01) in low-level epidemics. The greatest share of HIV resources going to prevention was in low-level epidemics, where 45% of funds went to prevention, compared to 20% in concentrated epidemics and 21% for generalized epidemics. Figures , and provide a breakdown of HIV spending by epidemic type and income level for all countries. Prevention spending patterns vary greatly, even among similar epidemic profiles and income levels.
Proportional distribution of AIDS spending in 15 low-level epidemics, by income level 2008 (USD).
Proportional distribution of AIDS spending in 28 concentrated epidemics, by income level 2008 (USD).
Proportional distribution of AIDS spending in 26 generalized epidemics, by income level 2008 (USD).
Currently, prevention relies heavily on international donors. On average 38% of total financing for prevention came from domestic-public sources, in contrast to the 63% of total treatment expenditures that were funded domestically. International funding for prevention was highest in low-income countries, where it reached a median value of 95% (Range 24-100%), compared to 59% (Range 0-100%) in lower-middle income countries and 8% (Range 0-100%) in upper-middle income ones. In 46 countries, international sources were responsible for over 60% of prevention resources, with contributions of greater than 80% in 31 of those countries. The majority of these are low-income countries, although this group also included Equatorial Guinea.
Many of the countries benefitting from international assistance were from sub-Saharan Africa, which registered both the highest levels of per capita spending on prevention and the greatest proportion of resources coming from international donors. Sub-Saharan Africa received 90% of its prevention resources from international donors, compared to 62% in South and South East Asia, 54% in Eastern Europe and Central Asia, 27% in the Middle East and North Africa, and 15% in Latin America and the Caribbean. Per capita, sub-Saharan African countries spent US$ 1.01 on prevention, the highest among any other region. Eastern Europe and Central Asia was the second highest spender at US$ 0.67 per capita, followed by Latin America and the Caribbean at US$ 0.43, South and South East Asia at US$ 0.21 and the Middle East and North Africa at US$ 0.12.
In absolute terms, Kenya (US$ 158. 6 million), Uganda (US$ 64.2 million), Nigeria (US$ 57.9 million), Mexico (US$ 50.6 million) and Thailand (US$ 45.3 million) are the biggest prevention spenders. Botswana (US$ 15.37), which has invested heavily in its AIDS programs in recent years, has the highest per capita spending, followed by Lesotho (US$ 4.84), Kenya (US$ 4.14), Rwanda (US$ 3.16) and Gabon (US$ 3.11). Figure is a representation of the 25 countries that spent the most on prevention and it shows both domestic and public sources of finance. Among the top 25 spenders, 12 relied on international sources for over 75% of their expenditures.
Annual prevention spending from public and international sources, 25 top spending countries, 2008 (USD).
Table (Total and proportional spending per prevention category in 53 countries, by epidemic type, 2008 (USD thousands)) presents expenditure by type of epidemic in relation to 23 prevention categories for the subset of 53 countries that provided detailed reports. Communication for social and behavioral change (16%), voluntary counselling and testing (14%) and prevention of mother-to-child transmission (13%) received the largest share of funds. These were followed by blood safety (10%) and prevention and treatment of STIs (6%). Notably, male circumcision and post-exposure prophylaxis both received less than 1% of overall prevention funding. Condom-related categories including, social marketing, public and commercial sector male/female condom provision, accounted for 7% of funding.
Total and proportional spending per prevention category in 53 countries, by epidemic type, 2008 (USD thousands)
Programs for the most-at-risk-populations (MARPS) each received 3% or less of overall funding, although proportional spending was higher in low-level epidemics. Overall, low-level epidemics spent 25% of their prevention budget on higher risk groups, compared to 12% in concentrated epidemics and just over 1% in generalized epidemics. This was due mainly to higher investments in harm reduction programs, which received 15% of prevention funds in low-level epidemics, compared to 5% of total resources in concentrated epidemics and less than 1% in generalized epidemics. Programs for MSM were allocated 4% or less of resources in each epidemic type, while initiatives targeting CSWs received 6% or less.