Revisiting aid dependency for HIV programs in Sub-Saharan Africa

Area of Science:

• Public Health
• Health Economics
• Global Health

Background:

• Global domestic HIV expenditure masks performance variations in sub-Saharan African (SSA) countries.
• Understanding local resource allocation for HIV programs in SSA is crucial for sustainable responses.

Purpose of the Study:

• To explore the patterns and correlates of domestic HIV expenditure in sub-Saharan African countries.
• To identify factors influencing the proportion of domestic funding for HIV programs in SSA.

Main Methods:

• A cross-sectional ecological study analyzing data from 30 SSA countries (2012-2017).
• Examined domestic HIV expenditure as a percentage of total expenditure.
• Assessed correlations with HIV prevalence, antiretroviral coverage, Gross National Income (GNI) per capita, and general government health expenditure (GGHE-D) per capita.

Main Results:

• Median domestic HIV expenditure was 24.9%; 50% of countries spent ≤25% domestically.
• Public sources constituted over 75% of domestic HIV expenditure in 77% of countries.
• Gross National Income (GNI) per capita was a significant positive correlate of domestic HIV expenditure.

Conclusions:

• Many SSA nations remain dependent on external funding for their HIV response.
• Economic growth is important, but governments can enhance HIV funding through innovative domestic mechanisms.
• Strengthening fiscal space for HIV programs requires strategic, inward-looking funding solutions.