Izazola-Licea José Antonio, Wiegelmann Jan, Arán Christian, Guthrie Teresa, De Lay Paul, Avila-Figueroa Carlos
AIDS Financing and Economics Division, Joint United Nations Program on AIDS (UNAIDS), Geneva, Switzerland.
J Acquir Immune Defic Syndr. 2009 Dec;52 Suppl 2:S119-26. doi: 10.1097/QAI.0b013e3181baeeda.
To describe levels of national HIV spending and examine programmatic allocations according to the type of epidemic and country income.
Cross-sectional analysis of HIV expenditures from 50 low-income and middle-income countries. Sources of information included country reports of domestic spending by programmatic activity and HIV services. These HIV spending categories were cross tabulated by source of financing, stratified by type of HIV epidemic and income level of the country and reported in international dollars (I$).
Fifty low-income and middle-income countries spent US $ 2.6 billion (I$ 5.8 billion) on HIV in 2006; 87% of the funding among the 17 low-income countries came from international donors. Average per capita spending was I$ 2.1 and positively correlated with Gross National Income. Per capita spending was I$ 1.5 in 9 countries with low-level HIV epidemics, I$ 1.6 in 27 countries with concentrated HIV epidemics and I$ 9.5 in 14 countries with generalized HIV epidemics. On average, spending on care and treatment represented 50% of AIDS spending across all countries. The treatment-to-prevention spending ratio was 1.5:1, 3:1, and 2:1 in countries with low-level, concentrated and generalized epidemics, respectively. Spending on prevention represented 21% of total AIDS spending. However, expenditures addressing most-at-risk populations represented less than 1% in countries with generalized epidemics and 7% in those with low-level or concentrated epidemics.
The most striking finding is the mismatch between the types of HIV epidemics and the allocation of resources. The current global economic recession will force countries to rethink national strategies, especially in low-income countries with high aid dependency. Mapping HIV expenditures provides crucial guidance for reallocation of resources and supports evidence-based decisions. Now more than ever, countries need to know and act on their epidemics and give priority to the most effective programmatic services.
描述各国在艾滋病病毒方面的支出水平，并根据疫情类型和国家收入情况研究项目拨款情况。
对50个低收入和中等收入国家的艾滋病病毒支出进行横断面分析。信息来源包括按项目活动和艾滋病病毒服务列出的国内支出的国家报告。这些艾滋病病毒支出类别按资金来源进行交叉列表，按艾滋病病毒疫情类型和国家收入水平分层，并以国际美元（I$）报告。
2006年，50个低收入和中等收入国家在艾滋病病毒方面支出26亿美元（58亿美元国际美元）；17个低收入国家中87%的资金来自国际捐助者。人均支出为2.1国际美元，与国民总收入呈正相关。在9个艾滋病病毒疫情低发的国家，人均支出为1.5国际美元；在27个艾滋病病毒集中流行的国家，人均支出为1.6国际美元；在14个艾滋病病毒广泛流行的国家，人均支出为9.5国际美元。平均而言，护理和治疗支出占所有国家艾滋病支出的50%。在艾滋病病毒疫情低发、集中流行和广泛流行的国家，治疗与预防的支出比例分别为1.5:1、3:1和2:1。预防支出占艾滋病总支出的21%。然而，在艾滋病病毒广泛流行的国家，针对高危人群的支出不到1%；在艾滋病病毒低发或集中流行的国家，这一比例为7%。
最显著的发现是艾滋病病毒疫情类型与资源分配之间的不匹配。当前的全球经济衰退将迫使各国重新思考国家战略，尤其是在高度依赖援助的低收入国家。绘制艾滋病病毒支出情况图可为资源重新分配提供关键指导，并支持基于证据的决策。各国现在比以往任何时候都更需要了解本国的疫情并采取行动，优先提供最有效的项目服务。
