Is AIDS Financing dying in Asia ? Swarup Sarkar Senior Adviser, UNAIDS, Geneva ICAAP, Busan, August 2010

In Collaboration with David Wilson, World Bank Tim Brown, East West Centre, Hawaii Jeanette Olsson, SVETAN, Stockholm Robert Greener, UNAIDS Rifat Atun, Global Fund Ryuichi Komatsu, Global Fund Carlos Avila, UNAIDS Pradeep Kakkattil, UNAIDS Sukontha Kongsin, Mahidol University, Thailand

Current level of Funding Extent of Shortfall Trend of Investment Effective & Efficient use What is the Future What should be done?

Funding Amount & shortfall

Estimated resources available and resource gap in the Asia-Pacific region AvailableNeed (billions USD)

Cost of a Priority Response InterventionsTotal Cost (millions USD) % of total High-impact prevention$1,33843% Treatment by ART$76124% Impact mitigation$32110% Programme Management$36312% Creation of an Enabling Environment$35911% Total$3,143100% Average total cost per capita ranges from $0.50 to $1.70, depending on the stage of the epidemic.

Comprehensive interventions $0 $1,000,000 $2,000,000 $3,000,000 $4,000,000 $5,000,000 $6,000,000 $7,000,000 Total Resource Need UNAIDS Method Priority Resource Need- AIDS Commission Total Program Management Income generation for widows Orphans and vulnerable children Total Treatment Community mobilization PEP Youth in school Mass media Prevention for PLHA Blood safety Condom social marketing Special populations Workplace STI management Youth out of school Safe Injection Universal precautions Public and commercial condoms PMTCT VCT MSMs Harm reduction CSWs and clients 6 B 3 B

Shortfall 2 /3 rd core 5/6 th of comprehensive Need

Trend of Investment

Investment is Plateauing…. * *varies between 800 to million USD

Shifting of Hands in Donor Resources

Trend Dramatic increase after UNGASS’01 Slowing after economic crisis Less significant increase last 2 yrs Domestic resources increasing, not enough

Follow same global trend : resources available for AIDS 1986– US$ million billionc Signing of Declaration of Commitment on HIV/AIDS, UNGASS Less than US$ 1 million World Bank MAP launch Global Fund PEPFAR 257 UNAID S Gates Foundation c 8.9 billion 10 billion 7.1 Source: UNAIDS & WHO unpublished estimates, billion Follow same global trend of economic boom and recession

Are We Using Money Effectively & Efficiently ?

Types of Intervention and Financing

Resources do not follow priorities

8 to 20% of resources only to Most at Risk Population 2 to 3 % resources to the community organisations Gate keepers and brokers …. Where is the money gone ?

Where is all the Money Gone ? Three reasons why community don’t see money

In the largest bilateral funding on harm reduction in Asia….. -50% to 96% resources were consumed by UN, Government and international NGOs -Money left for service was 4 to 50%

Resource go to non priority and not core interventions Resources go to non effective intervention Resource goes to non-intervention and sometimes to unwanted interventions

In spite of the AIDS Commission recommendation …. Time bound hand over to Community organisations Direct funding to the NGOs through Community organisations

Conditions Tied to Funding There is no evidence that testing changes behaviour of high risk groups however, GF continues to tie funding for high risk group with number of testing

What the Future holds ……

Increase Health Budget, Increase Donor Budget Increase AIDS Budget

1. Asia has the lowest health budget in the world 2. Low impact prevention ( critical enablers) to shift to health budget 3. Cost sharing with other Ministry, a must

Commission on AIDS in Asia – Projections and Implications 27 Most of Asia are least Funded countries on Health (Health expenditure as % GDP) Region %Country% SE Asia India 4.2 Africa China 4.3 America Indonesia 2.3 Euro Philippines 3.7

Increase AIDS Budget, Increase Health Budget, Increase Donor Budget 1. Asia has the lowest health budget in the world 2. Low impact prevention ( critical enablers) to shift to health budget 3. Cost sharing with other Ministry

Implications for resource need: more efficient and effective use of resources $0 $1,000,000 $2,000,000 $3,000,000 $4,000,000 $5,000,000 $6,000,000 $7,000,000 Total Resource Need UNAIDS Method Priority Resource Need- AIDS Commission Total Program Management Income generation for widows Orphans and vulnerable children Total Treatment Community mobilization PEP Youth in school Mass media Prevention for PLHA Blood safety Condom social marketing Special populations Workplace STI management Youth out of school Safe Injection Universal precautions Public and commercial condoms PMTCT VCT MSMs Harm reduction CSWs and clients 6 B

Impact mitigation: Livelihood sustainability for widows Lifetime cost of $1000 per affected household Positive Partnership‘: micro-financing for affected households ($600 USD loans)

Impact mitigation: care and support for children orphaned by AIDS Estimated at 100 USD per child per year 1 million children in Asia lost at least one parent to HIV Total cost=100m USD

Increase AIDS Budget, Increase Health Budget, Increase Donor Budget 1. Asia has the lowest health budget in the world 2. Low impact prevention ( critical enablers) to shift to health budget 3. Cost sharing with other Ministry 4. Independence from donor funding

Overall International Fund: 53 % from > 90% in 2002* * Not including Thailand in 2002

Who Should Fund ? Rhetoric's between donor and recipient countries. Economic progress does not lead to social equity Economic Crisis in north can’t be turned into humanitarian crisis in south Health for marginal people remains a shared responsibility

Summary: where we are Current HIV resources too low to create impact Early sign: donor fatigue, funding yet to reverse Increasing but insufficient domestic budget Neglected MARP priority Poor Cost sharing with health and Social sector

"It is no longer our resources that limit our decisions; its our decisions that limit our resources." - U Thant

A resurgent epidemic? Or a contained one?

For Countries of the Region… Action now can save -5 million new infection -Avert 2 million deaths -Protect 80% of women and children from AIDS impact -USD 2 billion by 2020 – cost of econmic burden to family

No substitute for activism

The Future is Ours