Photo by Bulat Silvia on istock
By Masen Davis, Executive Director, FCAA
Racism, transphobia, and homophobia. Authoritarianism, closing civic space, and political instability. Climate change and conflict. Attacks on sexual and reproductive health and rights. The politicisation of HIV funding. These threats are raging all at once and are fueled by common antagonists.
Despite decades of progress, nearly 40 million people are living with HIV globally, more than half of whom are women and girls. Young people aged 15-24 make up more than a quarter of new infections due to a lack of access to HIV and sexual and reproductive health services. The situation is most acute in sub-Saharan Africa, home to two-thirds of the world’s People Living with HIV (PLWH). Key populations—including transgender people, gay men and other men who have sex with men (MSM), sex workers and their sexual partners, and people who use drugs—are disproportionately impacted, accounting for 70% of HIV infections globally and 94% of HIV infections outside of sub-Saharan Africa1. PLWH are also close to 40% more likely to develop severe fatal Covid-19 than those without HIV2.
It doesn’t have to be this way.
Unlike in prior decades, we finally have the medical knowledge and tools to bring an end to AIDS in our lifetimes. Yet intersecting structural and societal barriers – including stigma and discrimination, economic disparities, racial injustice, gender inequality, criminalisation, migration, geopolitical conflict, and inequitable access to healthcare – conspire to keep the vision of a post-AIDS future out of reach. Indeed, the experiences of people living with and vulnerable to HIV bring to light what is often hiding in the shadows. For example, we commonly see new HIV transmissions climb within countries impacted by political repression, anti-LGBTQ+ policies, war, and other crises.
In the earliest days of Funders Concerned About AIDS (FCAA), the organisation’s advocacy highlighted how broader philanthropy could and should play a role in responding to HIV. Our messages included the reminder that regardless of what you funded, you too could fight HIV.
It is time once again to call on the sector to work collectively and to urge a more integrated, united response to today’s shared threats.
Communities under attack
Across the world, a confluence of crises is being leveraged to limit civil society advocacy and spaces and to restrict basic human rights. Recent data from the Global Fund to Fight AIDS, Tuberculosis, and Malaria has highlighted how the closing of civil society spaces has a direct impact on people’s health, finding that in 2021, 78% of deaths from HIV, TB and malaria—and 83% of new infections—occurred in countries where civil society was classified as closed or repressed3.
These experiences are not limited to any one region of the world.
In the United States, the reauthorisation of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the largest single donor to the global HIV response and for years one of the most successful examples of U.S. bipartisanship, has been delayed and increasingly politicised due to erroneous claims from some lawmakers that it is used to fund abortions.
In Russia, LGBTQI organisations were recently outlawed as “extremist groups”, and people living with HIV in Russia-occupied territories within Ukraine report being denied access to antiretroviral treatment unless they submit to becoming Russian citizens.
Under Uganda’s new Anti-Homosexuality Act, having same-sex relationships while living with HIV can incur a charge of “aggravated homosexuality,” which is punishable by death. The act of “promoting homosexuality” – which can include housing or employing an LGBTQ person or not reporting an LGBTQ person – now also comes with a sentence of up to 20 years in prison. While data is unclear, some clinics have already reported upwards of 50% declines in HIV prevention and care services – a warning of an inevitable resurgence of HIV in the country.
And worldwide, a well-resourced anti-gender movement further threatens to propagate similar policies into more countries with the goal to marginalise and criminalise transgender women, further reversing gains in the response to HIV.
Disparities in funding
As highlighted in FCAA’s recent annual report ‘Philanthropic Support to Address HIV and AIDS’, HIV-related philanthropy decreased by 1% ($9 million) from 2020 to 2021. Despite what may appear to be a minor decrease, waning support for HIV is not an anomaly. When adjusted for inflation, today’s philanthropic investments are lower today than they were in 2018. Another troubling trend is that the majority of funding is disbursed by only a few institutions: The top 20 funders accounted for 92% of total funding in 2021.
Data also revealed that a disproportionate amount of funding reached West and Central Europe and North America (predominately the U.S.), while East and Southern Africa received only 26% of funding, despite being home to more than half of the world’s people living with HIV. Two of the only regions where HIV infections continue to increase—Eastern Europe and Central Asia, and North Africa and the Middle East—received 2% and less than 1% of all HIV funding, respectively.
The report also highlighted that approximately $22.6 billion in public and private resources – of which philanthropy is just 2% – was invested annually in the HIV and AIDS response in low- and middle-income countries (LMIC) in 20214, falling well short of global targets to end AIDS by 2030.
Shared fates
While the gaps and challenges loom large over the HIV response, the need for philanthropic attention is clear. Philanthropy has supported an ecosystem of social justice and public health — from LGBTQ+ community organising and advocacy to maternal health and well-being.
It has, for example, supported organisations like Espace Confiance in Abidjan, Côte d’Ivoire, to become a safe harbour for sex workers and LGBTQ+ communities. Flexible funding has allowed them to expand from a traditional clinic model to provide capacity building, advocacy, and gender-based violence services. In Suriname, HIV and AIDS remain one of the leading causes of mortality, with the majority of new HIV infections occurring among key populations and their sexual partners. The Suriname Collection of Sex Workers has leveraged participatory funding – namely through the Red Umbrella Fund – to support and empower the sex worker community, link migrants to care and treatment, and prioritise poverty alleviation efforts that support families to survive.
These examples of innovation point to a solution: Supporting the people and places most impacted by HIV will not only end the epidemic, but it will also increase access to healthcare, racial and gender justice, sexual and reproductive health and rights, and democracy in the long run.
So, are you a funder concerned about HIV and AIDS? Before you answer that question, we urge you to think about the issues you do fund. Think about the populations most impacted by those issues. I would venture to guess that people affected by HIV compose a significant percentage of that group.
Our opposition, the anti-rights and anti-gender movements know this well and are quite adept at connecting their work across rights, health, and access. It’s time we do the same.
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For organisations interested in learning more about how HIV intersects with your work, FCAA would be happy to provide technical assistance or to collaborate on an informational webinar or content for your membership. Please contact sarah@fcaaids.org for more information.
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1. USAID. Key Populations: Achieving Equitable Access To End AIDS. https://www.usaid.gov/global-health/health-areas/hiv-and-aids/technical-areas/key-populations
2. World Health Organization. Coronavirus disease (COVID-19) and people living with HIV. https://www.who.int/news-room/questions-and-answers/item/coronavirus-disease-(covid-19)-covid-19-and-people-living-with-hiv
3. Global Fund to Fight AIDS, Tuberculosis and Malaria. Advocacy Roadmap: 2023-2025. https://www.theglobalfund.org/media/13367/publication_advocacy-roadmap_report_en.pdf
4. The Henry J. Kaiser Family Foundation (KFF) and UNAIDS. Donor Government Funding for HIV in Low- and Middle Income Countries in 2021. San Francisco: KFF. July 2022. https://files.kff.org/attachment/Report-Donor-Government-Funding-for-HIV-in-Low-and-Middle-Income-Countries-in-2021.pdf
Masen Davis, Executive Director, FCAA
Masen Davis (He/Him) is a seasoned social justice leader and nonprofit executive who has spent more than twenty years advancing human rights and healthcare for vulnerable populations. Before joining FCAA, Masen most recently served as interim executive director of Transgender Europe, a membership-based network and a voice for the trans community, representing 183 organizations across 47 countries in Europe and Central Asia.
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