Foreword

For over two decades, the annual resource tracking report from Funders Concerned About AIDS has been a beacon illuminating the landscape of HIV-related philanthropy. Our goal is to create data-based evidence that will help funders align resources with critical needs and support the people and places most impacted by HIV. This year marks the 21st edition of the report, and analyzes data on calendar year 2022 grantmaking.

• Giving remains concentrated among few donors, with the top 20 funders—according to HIV disbursements—responsible for 84% of total giving in 2022.
• If we compare the giving of only the funders that we have 2021 and 2022 data for, the result is an even starker 13% decrease in overall funding. This validates that we’re ultimately bearing witness to a decline in funding from many longstanding grantmakers in the field, including the Open Society Foundations, which fell from the top 20 list for the first time in 20 years.
• After spiking up due to a large research grant in 2021, funding focused on women and girls—who represent 53% of the world’s people living with HIV (PLWH)—declined by 45% in 2022, marking its lowest level in six years.
• Globally, key populations—including transgender persons; gay, bisexual, and other men who have sex with men; people who use drugs; and sex workers—and their sexual partners account for 55% of new HIV infections—and upwards of 80% outside of sub-Saharan Africa—but only received 18% of total HIV philanthropy in 2022. HIV-related philanthropy for key populations is not increasing in proportion to meet the critical needs of these diverse populations. Overall, there was a small 4% increase in funding for key populations from 2021 to 2022, although it was not experienced evenly across population groups. Only funding for trans communities increased slightly, as well as grants to LGBTQI populations in general and key populations where no specific subpopulations were identified.
• Funding that addressed or was impacted by the COVID-19 pandemic decreased by 47% in 2022, despite its ongoing and chronic impact on PLWH.

• The report includes new intersectional donors—mainly with a focus on human rights and LGBTQI communities—on the top 20 list for the first time.
• General Operating/Core Support—one of the most effective strategies to build and mobilize community responses—totaled US$72 million in 2022, representing an impressive 60% increase from 2021.
• Following the full-scale Russian invasion of February 2022, funding to Ukraine increased by an incredible 571%, causing a slight overall increase to the Eastern Europe and Central Asia region, one of two global regions where new HIV infections continue to rise.

It is important to remember that these statistics do not occur in a vacuum—they impact real people.

With 39 million people living with HIV in the world today, philanthropy’s US$659 million roughly equates to a meager US$17 per person living with HIV. Antiretroviral treatment (ART), when accessible, is a lifetime cost—ranging from US$45 per year in Global Fund grant-implementing countries1 to US$36,000 annually in the U.S.2—and doesn’t account for the critical need for supportive housing, employment, and mental healthcare services to often ensure its success. Further yet, 9 million PLWH still lack access to ART.

Thankfully philanthropy isn’t alone, and governments have an important role to play. However, according to UNAIDS and KFF,3 donor government funding to HIV is “stable but stagnant,” and although it increased to US$8.2 billion in 2022, it is still far below its high-water mark in 2014. Importantly, bilateral funding— provided directly to or on behalf of specific countries rather than to multilateral organizations— from all other countries except for the U.S. has been on the decline for the past decade. Notably, according to UNAIDS, annual funding was nearly US$ 9 billion short of the US$29.3 billion needed by 2025 to reach our goals of ending AIDS as a public health threat by 2030.

There is always a delicate dance when writing this report. The data is historical, but the HIV response is current, and increasingly urgent. We look at the data within the year of its context, but we also know what’s coming: a fraught road within a global election year; a contentious and temporary reauthorization of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR); inequitable access to HIV prevention, treatment and services; continued war and displacement in many parts of the world; rising infection rates in Eastern Europe and Central Asia (EECA) and the Middle East and North Africa (MENA); the passage of inhumane laws against LGBTQI communities in Belarus, Georgia, Ghana, Iraq, Kyrgyzstan, Uganda, and the U.S.; and waning philanthropy in many sectors. In 2023, total U.S. charitable giving also dropped, for the first time since 2021.

Unlike the earliest days of the epidemic, we now have the medical knowledge and tools to bring an end to AIDS in our lifetimes. Cities and even entire countries, such as Amsterdam and Australia, have rallied across sectors to move closer to a reality of no new HIV infections.

Yet intersecting structural and societal barriers—including stigma and discrimination, economic disparities, racial injustice, gender inequality, criminalization, 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-LGBTQI policies, war, and other crises.

The field of HIV philanthropy began with a calling in: a demonstration to broader philanthropy how their resources and leadership could make a difference in the fight against HIV.

Today, that calling reverberates once more. Why should this matter to you?

If you are a long-time HIV funder, the work is not done. We need you to stay in the game to sustain the infrastructure and civil society advocacy that has helped to build the HIV movement and is needed now more than ever.

If you are at a feminist fund or women’s foundation, we want you to understand and address the significant risks that HIV poses to the education, economic advancement, and sexual and reproductive health and rights of adolescent girls and young women around the world.

If you’re a human rights, democracy, or health funder, we want you to see the direct link between the closing of civil society spaces and people’s health. Recent data from the Global Fund to Fight AIDS, Tuberculosis, and Malaria found that in 2021, 78% of deaths from HIV, tuberculosis, and malaria—and 83% of new infections— occurred in countries where civil society was classified as closed or repressed.⁴

Indeed, we have seen the provision of flexible funding—a rallying cry and strategy across portfolios—help HIV clinics in Côte d’Ivoire become safe harbors for LGBTQI communities. And participatory grantmaking in the Caribbean has empowered sex workers not only to address HIV, but also the syndemics facing their communities, including migration and poverty.

These examples 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.

There is further cause for optimism. In 2022, we witnessed the emergence of intersectional funders, many with a focus on human rights and LGBTQI communities, breaking into the top 20 for the first time. Their presence is not only welcomed but urgently required, as key populations disproportionately bear the brunt of the HIV epidemic. We also see the debut of Mackenzie Scott’s Yield Giving, with a first infusion of available data on HIV-related giving.

This report also heralds a more than 500% increase in funding to the Ukraine, following the full-scale Russian invasion of February 2022. FCAA partnered with Aidsfonds to mobilize a donor working group of more than 20 funding organizations to coordinate resources to the country with an emphasis on reaching key populations impacted by HIV. That increase in funding is a direct result of those donors’ leadership and advocacy. The working group has since grown to include new humanitarian and human rights-based donors who understand the ways in which our funding intersects and that together, we can better address the needs of vulnerable populations that are often unable to access humanitarian aid. The group is now leveraging these insights and resources to address emerging needs throughout the region in response to the continued conflict, forced migration, and increasing authoritarianism in the region.

We hope that you can see a place for your work within this report, and that the data will support your advocacy—within your institutions and beyond—to ensure philanthropic resources reach the people and places most impacted by HIV.

We share our gratitude to the efforts of all the grantmakers and grantees whose work, innovation, and resilience are represented within these data.

In Solidarity,

Masen Davis
Executive Director
Funders Concerned About AIDS