The past twelve years have witnessed a spectacular forty fold increase in the amount spent on HIV/AIDS efforts in low- and middle–income countries—from a mere $250 million in 1996 to $10 billion in 2007. Although global resources for HIV/AIDS still fall short of meeting the estimated need for a comprehensive response, the creation of innovative funds, unprecedented bilateral programs, and restructured programs within multilateral agencies have fundamentally changed the fight against HIV/AIDS and the way in which the world engages global health. The increase in donor assistance for HIV/AIDS has led to tremendous achievements in providing access to treatment and care.
The current economic crises reveal the vulnerabilities of programs reliant on a constant flow of external funding. The downturn also threatens to marginalize health and development agendas, as donor attention is focused on emergency schemes to prevent global financial catastrophe. Although the outlook is bleak and the full impact of the economic downturn is still unknown, it may provide an opportunity for the donor community to strategically reevaluate what is working, and what is not with an eye to maximizing the value of every dollar, yen, and euro spent in global health and development.
In the near term, donors’ efforts and proximity to achieving the MDGs in 2015 may further define the levels of commitments to fund health and development. Failure to come close to meeting the goals may lead to donor fatigue.
In the longer term, the rise of new economic powers and growing influence of non–state actors will shape the world’s power structures and global institutions. The rise of new economic powers and increasing clout of new actors may make collective action difficult to achieve and maintain.
There are a number of actions that the donor community and national governments can undertake now to secure sustained funding and transform emergency responses into sustainable engagements through the fiftieth anniversary of the HIV/AIDS pandemic in 2031 and beyond.
