President's Emergency Plan for AIDS Relief

UNAIDS’ Update highlights key elements of the AIDS response in a number of African countries. South Africa, for example, is rapidly scaling up access to HIV treatment, with a 20% increase in the number of people receiving therapy from 2011-2012 alone. Sixteen countries—Botswana, Ghana, Gambia, Gabon, Mauritius, Mozambique, Namibia, Rwanda, São Tomé and Principe, Seychelles, Sierra Leone, South Africa, Swaziland, Tanzania, Zambia, and Zimbabwe—now ensure that more than three-quarters of pregnant women living with HIV receive antiretroviral medicine to prevent transmission to their child. 

While donor funding for health in low and middle-income countries rose significantly in the last decade, the era of rapid growth has come to an end. Health increased as a share of Official Development Assistance (ODA) during the early part of the past decade, largely spurred on by the creation of several new funding initiatives and mechanisms such as The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). However, this share has remained essentially flat in recent years, with year-to-year increases in donor funding for health peaking in 2007, and declining each year since.

HIV/AIDS imposes enormous economic, social, health, and human costs and will continue to do so for the foreseeable future. The challenge is particularly acute in Sub-Saharan Africa, home to two-thirds (22.5 million) of the people living with HIV/AIDS globally, and where HIV/AIDS has become the leading cause of premature death. But now, after decades of misery and frustration with the disease, there are signs of hope. HIV prevalence rates in Africa are stabilizing. This book sheds light on these concerns by analyzing the fiscal implications of HIV/AIDS in Southern Africa, the epicenter of the epidemic. It uses the toolbox of public finance to assess the sustainability of HIV/AIDS programs.

A period of major change is unfolding in health and HIV services in South Africa, carrying opportunities and risks for delivering effective, integrated health services that improve health outcomes and save lives. South Africa is decentralizing HIV services to the primary health care level, paving the way for greater integration to address women’s health and to reduce maternal mortality. The United States can find feasible, flexible ways to support this process, even though its health program through the President’s Emergency Plan for AIDS Relief (PEPFAR) is scaling down.