AIDS may have dropped off the front pages in recent years, but it remains a serious health threat for millions around the world — including in the U.S. Unfortunately, philanthropic giving for HIV and AIDS has been trending down for years: The latest giving estimates, from 2022, show a 6% decrease in grantmaking from the previous year.
Meanwhile, HIV is surging in various hotspots around the world, including Eastern Europe, Central Asia and countries of the Middle East and North Africa. These are regions where military conflicts and anti-LGBTQ+ policies and laws often contribute to inadequate healthcare and support for people with HIV and AIDS. In the U.S., too, communities in the South, and Black people in particular, continue to experience disproportionate rates of HIV.
We have a pretty good idea of the size of global HIV-related philanthropy thanks to the organization Funders Concerned About AIDS (FCAA), which coordinates donors around the world to advance research and advocacy. For more than 20 years, FCAA has conducted annual surveys of HIV and AIDS grantmaking, released in its annual “Philanthropy’s Response to HIV and AIDS” reports. FCAA recently released its latest report in the series, covering global grantmaking from the year 2022, with data from 767 funders, 6,000 grants and 2,700 grantee organizations.
First, some of the numbers from that survey. The FCAA analysis estimates total 2022 HIV grantmaking at $659 million: The 6% decline from the previous year is the largest single-year decrease since 2017. Previous years have also shown dwindling HIV funding, but the 2022 total was further diminished by the redirection of health funding to the COVID-19 pandemic. Also worrisome, fewer funders are focusing on HIV and AIDS, with the top 20 HIV funders comprising 84% of the total. That top heaviness leaves the field vulnerable should any one of those large funders decide to shift grantmaking elsewhere.
A few more of the report’s key findings:
Not surprisingly, the decline in philanthropic funding disproportionately impacts historically underserved communities, including women and girls. Though they make up 53% of people living with HIV, 2022 grantmaking for women and girls declined by 45% (though FCAA notes that such funding spiked in 2021 due to a large research grant). Meanwhile, girls aged 10 to 19 represent a sobering 71% of new HIV infections.
Globally, other populations at risk for HIV — including transgender people, men who have sex with men, people who use drugs, and sex workers — account for 55% of new infections outside of sub-Saharan Africa, yet received only 18% of philanthropic funding in 2022.
On a more positive note, Black people in the U.S. experienced a 13% increase in funding, the highest level to date. But Black people in the U.S. are also disproportionately impacted by HIV, representing approximately 40% of new HIV diagnoses in the U.S., despite being only 13% of the population.
I spoke with FCAA Executive Director Masen Davis recently about the current state of global HIV and AIDS grantmaking. He put the regional differences in funding into sharper perspective: People with HIV who live in Middle East and North African countries only receive about $8 per person, compared to people in the U.S. or Western Europe, who benefit from about $109 per person.
The toll of HIV is also tied to world events like military and political conflict. Not only can healthcare systems be disrupted in a country involved in war; displaced people with HIV who had been under treatment in peacetime frequently experience gaps in care as they organize treatment in a new country or location.
“When a community or a country is at war, when there’s political instability, when healthcare systems are impacted, we can anticipate that HIV rates will go up, that access to HIV medication becomes more challenging,” Davis said. Infections, for example, are surging in war-torn Ukraine — fortunately, however, public and philanthropic response has been encouraging in that country, which saw a 500% increase in HIV philanthropy in 2022.
Perhaps the key takeaway from my conversation with Davis was that HIV is as much an issue of human rights as it is of health.
“If you look at, for example, heterosexual women, there’s no way to think about ending HIV without addressing gender-based violence that women face in many environments, especially Black women in the U.S. and in the Global South,” Davis said. “And if you want to address the issue with gay men or transgender people, you have to stop criminalizing and attacking LGBT people.”
Those communities at risk for HIV in regions with human rights records continue to experience lower rates of the HIV testing, treatment and preventative care that can keep them healthy. It’s a life-and-death contrast in comparison with the care available to people in large cities in the U.S. and in wealthier countries.
Reasons for optimism
Happily, there are also encouraging lessons to be learned from the study of HIV responses around the world, Davis told me. In the Netherlands and Australia, for example, proper medical care and robust health surveillance and testing policies have kept new infection rates extremely low, demonstrating that HIV really is controllable.
There is every reason to believe that HIV and AIDS can be eradicated. People with HIV can maintain life-long good health with medicines that can keep the virus down to undetectable levels within their body — levels at which they’re unable to transmit the virus — while other drugs can prevent infection in the first place. A newly published clinical research study, for example, showed that a convenient, twice-yearly injection can prevent HIV infections. That study involved more than 5,300 adolescent girls and young women in South Africa and Uganda, where women are at comparatively high risk for HIV. But none of the study participants who received the injections contracted HIV, suggesting yet another potential tool in the fight against AIDS — if it can be deployed to the people who need it.
“We actually have a choice today to end HIV as a global public health threat,” Davis said. “We know how to do it, yet we’re still not putting in the resources — whether they’re government resources, multilateral resources or private sector resources.”
So why are funding numbers of HIV and AIDS consistently trending in the wrong direction? Where private philanthropy’s concerned, donor fatigue may be part of the issue. Despite its continued lethality, the HIV and AIDS epidemic is decades old by now, and many funders turn their focus to the next big thing.
In addition, the very fact that HIV and AIDS are now relatively easily treatable and even preventable makes this seem like a less serious crisis – at least to those with the wealth and privilege to access those treatments. People in that category tend to control the philanthropic pursestrings, and, unfortunately, they’re often far removed from the groups still at high risk from the virus.
Like so many public health challenges, quashing HIV is a matter of political will, Davis said. “That’s one reason we urge funders of all kinds to come together to invest now, because if we actually invested adequately now, we can turn some of these numbers around, we really can get ahead of this thing.”
Indeed, the data and analysis in the FCAA report reveals a missed opportunity for philanthropy, particularly at this point in the encouraging progress of medical research around the HIV virus. Not to take advantage of these resources and advances will cost more, in both lives and money, in the long run.
“We have more people living with HIV than ever,” Davis said. “The HIV pandemic is going to get more expensive over time, not less.”
