UNAIDS Program Coordinating Board Meeting

10 December 2009

Geneva

The Impact of the Global Economic Crisis on HIV and AIDS

“report at the 25th Programme Coordinating Board

Meeting on the anticipated impact that the financial

crisis will have on countries’ ability to meet their

universal access targets and to include

recommendations and mitigation strategies.”

The context

At the 24th Meeting of the UNAIDS Programme Coordinating Board in June, the Board requested that UNAIDS:

1. UCCs surveya. March survey 71 responses

b. July survey 63 responses

2. CSOs surveya. PCB Delegates provided the list of NGOs

b. 458 CSOs started the survey and 80 fully completed it

c. CSOs respondents from 75 countries

3. Country Case studiesa. 12 country case studies

4. Cosponsor’s contributions

5. Donor’s interviewsa. Structured interviews with the top five bilateral donors plus

the Global Fund and World Bank

Monitoring system: sources of information

Reported and expected impact is getting worse (UCCs July Survey)

Percentage of countries in each region where funding reduction is expected to affect prevention

AP Caribbean ESAF ECA LA MENA WCA

VCT 18% 67% 36% 20% 33% 67% 25%

Condoms 18% 67% 27% 50% 33% 67% 23%

AIDS education 18% 67% 27% 30% 33% 0% 19%

IDUs programs 18% 33% 9% 60.0 17% 67% 17%

MSM programs 36% 100% 18% 30% 50% 67% 24%

SW programs 46% 100% 36% 30% 33% 67% 28%

Human rights and advocacy

18% 100% 18% 30% 50% 33% 24%

Reduction of stigma and discrimination

27% 100% 18% 50% 50% 0% 27%

Violence against women

18% 100% 9% 20% 17% 0% 15%

Empowerment of young people

36% 67% 27% 40% 17% 33% 26%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

2003 2004 2005 2006 2007 2008 2009 2010

32 off-track

19 on track

Universal Access off-track (Coverage of ART for illustration)

12 not available

• Economic slowdown and external shocks

• Flat international resources

• Competing priorities for development assistance

• Growing uncertainty at the country level

II. What are the driving forces?

Macro and Micro Impacts related to HIV/AIDS

Country Context-Recent economic growth-Political stability-Health of government budget-Degree of financial integration through trade FDI, and remittances- Degree of dependence on external assistance

Macro Impacts-Lower GDP & GDP per capita growth-Reduced external flows (ODA, private capital flows, remittances)-Worsening terms of trade-Higher unemployment- Currency devaluation

Negative Impact on Other Actors (NGOs,

private sector)

Government Budget Cuts for Health and HIV

Lower Real Household Income and Increase in

Poverty

Negative Impact on Related Sectors

(Agriculture, Public Works)

Delivery of HIV Services- Lower purchasing power for imported commodities- Decrease in health and HIV human resources- Unplanned interruptions and eliminations of prevention programs - Shortages of ARTs; disorganized access to ARTs

Demand for HIV Services- Higher opportunity costs (transportation, food security and nutrition)- Increase in OOPs- Increase in risky behaviors?- Increase in stigma and discrimination?

Health Status of Populations- Increased morbidity and mortality- Increased risk of HIV transmission- Increased resistance to HIV/AIDS treatment

Economic Slow-Down and Shocks: UCCs reported risk factors

Factors perceived by CSOs to affect HIV and AIDS of the Crisis on HIV/AIDS

Impact of the Crisis on HIV/AIDS Programs: CSOs perspective

• Strategic planning: 20 countries

• Improved tracking, monitoring, evaluation 9 countries

• Economic analysis: of impact of crisis 8 countries

• Prioritization and efficiency: 8 countries

• Resource mobilization strategy: 7 countries

• Mitigation of the impact and Social protection package for poor AIDS affected households (1 country)

• Capacity building and strengthening the institutional capacity of civil society

What are the countries’ needs for technical assistance?

Interviews with major donors, plus the Global Fund and

World Bank, suggest that:

• Donors and International Financing Institutions are

striving to maintain financial support for AIDS in the

context of a very challenging environment

• There are significant shifts towards:

– funding for health systems and other development agendas.

– favouring countries with a high burden of disease and lower

income status.

The outlook for donors

1. Reported and expected impact is getting worse with the biggest impacts experienced by prevention programs delivered by CSOs

2. HIV funding is leveling off

3. Universal access goal is off track

What are the main findings?

I. Target better existing but constrained resources to protect priority services and populations including those delivered by CSOs.

II. Pursue greater efficiencies in existing programmes

III. Develop funding diversification strategies

IV. Increase the stability and predictability of funding

V. Expand “safety net” services for poor and vulnerable populations

What can be done to address the negative effects of the economic crisis on AIDS programs

Each and every one of us has a responsibility to improve the picture

of the response to HIV/AIDS!