After ten years, Bridging the Gaps is coming to an end. Together we have had a real impact in increasing access to prevention, treatment, care, and support for key populations. We have also enhanced the position of key population-led organisations, networks and movements, and demonstrated that their role in the HIV response is crucial.
The end of Bridging the Gaps does not mean investment in key populations is no longer needed. On the contrary, more than ever we need to make clear to donors and
governments that HIV and AIDS are not over, and more, and better, funding for key population programmes remains necessary. This campaign is an opportunity for us to raise much needed attention to the funding gaps that still exist and to make a clear call for more and better investment into key population HIV responses.
In 2016, the global community agreed to work together to end AIDS by 2030. United Nations Member States backed the UNAIDS Fast-Track strategy to realise this vision. Key populations were recognised as being central to achieving this ambitious goal. Yet, three years into the strategy, funding for HIV programming for key populations is way off track. To end AIDS by 2030 there needs to be a rapid scale-up of funding for effective HIV programmes for keypopulations.
In 2018, for the first time, key populations and their partners accounted for the majority – 54 per cent – of all new infections worldwide. This has since increased to 62%. In the Asia-Pacific, Eastern Europe, Central Asia, the Middle East, and North Africa, key populations accounted for more than 95 per cent new infections. Between 2016 and 2018, total combined resources for the HIV response in Lower and Middle Income Countries (LMICs) was approximately $57.3 billion, whereas the total funding of HIV programmes for key populations in LMICs is estimated at around US$1.3 billion. So, during the first three years of the Fast Track approach, programmes targeting key populations received only 2% of all HIV funding, even though key populations accounted for over half of all new infections in 2018.
The resource gap for HIV programming for key populations was much bigger than the funding gap for the overall HIV response in LMICs. In 2016, UNAIDS estimated that $6.3
billion was necessary for the delivery of comprehensive service packages for key populations between 2016 and 2018. Another $551 million was required for the distribution
of pre-exposure prophylaxis (PrEP) to these communities, making a total of $6.8 billion needed. So, there was a staggering gap of 80% between the budget required for HIV
programmes targeting key populations ($6.8 billion) and the amount made available ($1.3 billion).
The UN General Assembly Political Declaration (2016)1 acknowledged that not only are key populations at greater risk of HIV but that national programmes were failing them:
“[…] many national HIV prevention, testing and treatment programmes provide insufficient access to services for women and adolescent girls, migrants and key populations that epidemiological evidence shows are globally at higher risk of HIV, specifically people who inject drugs, who are 24 times more likely to acquire HIV than adults in the general population, sex workers, who are 10 times more likely to acquire HIV, men who have sex with men, who are 24 times more likely to acquire HIV, transgender people, who are 49 times more likely to be living with HIV…;” (Ibid para 42, p.9)
It also emphasized that:
“21. […] the meaningful involvement of people living with, at risk of and affected by HIV and populations at higher risk of HIV facilitates the achievement of more effective AIDS responses.” (Ibid para 21, p.5)
The Declaration went on to commit its signatories to:
“60 (d). “[…] building people-centred systems for health by strengthening health and social systems, including for populations that epidemiological evidence shows are at higher risk of infection , by expanding community-led service delivery to cover at least 30 per cent of all service delivery by 2030, through investment in human resources for health, as well as in the necessary equipment, tools and medicines, by promoting that such policies are based on a non-discriminatory approach that respects, promotes and protects human rights, and by building the capacity of civil society organizations to deliver HIV prevention and treatment services;” (Ibid para 63(a), p.21)
Despite the emphasis on support for key population programmes in the 2016 Declaration and after, the reality has not lived up to these commitments. For example, in the same year, UNAIDS estimated that in LMICs US$ 6.8 billion was needed for key population programming between 2016-2018, yet funding amounted to only US$1.3 billion – a gap of 80%.
The USD 1.3 billion funding in LIMCs that goes to key populations is broken down as follows:
USD 718.6 million (55%) Global Fund
USD 305.7 million (23%) PEPFAR
USD 131.5 million (10%) Private philanthropy
USD 93.2 million (7%) Public domestic spending
USD 56.1 million (4%) Dutch Government
USD 13.1 million (1%) Others
The available data reveals how large the gaps between estimates and the reality are:
○ 2% of all HIV funding goes to programmes targeting key populations
○ <1% of funding goes to programmes targeting gay and bisexual men in LMICs5
○ 0.06% of funding goes to programmes targeting transgender people in LMICs
○ 0.6% of funding goes to programmes targeting sex workers in LMICs (2016-2018)
○ 0.4% of funding goes to programme targeting people who inject drugs in LMICs
○ 20% of estimated resources for HIV programming for gay and bisexual men in 28
The campaign started on 1 November, following on from the Fast Track or Off Track? report launch, reinforcing the research recommendations with donor targets. It will conclude on World AIDS Day 2020 (1 December). Together we will aim to get our key messages in front of the decision makers and influencers who can help us achieve our objectives. We will do this publicly (via social media) and privately (through advocacy meetings and consultations).