Background Knowing the level of spending of the countries is the first step in examining the ability to take on a greater share of the financial burden to sustain a response to the HIV pandemic. The UNGASS Declaration of Commitment on HIV/AIDS was signed by 189 countries agreeing to achieve the Millennium Development Goal of halting and beginning to reverse the HIV/AIDS epidemic by 2015.
Objective The objective is twofold; to identify determinants for the domestic public expenditures on HIV and AIDS in low and middle income countries, and to predict the domestic public expenditures on HIV and AIDS for 2004.
Methods A cross-sectional analysis using multiple regression analysis to find determinants and to predict the level of spending on HIV in 136 low- and middle-income countries in 2004. Tests for robustness of the model specifications and assumptions were performed.
Findings The model predicted a total of 2.7 USD billions on domestic public expenditures on HIV and AIDS in 2004. We found four independent determinants for government spending; GDP (coefficient estimate = 1.256; p<0.001), political stability (coefficient estimate = 0.587; p=0.012), HIV prevalence (coefficient estimate = 0.095; p=0.002), and budget support per capita (coefficient estimate = 0.059; p=0.017). There were regional differences in the level of expenditures; 50% of the total amount came from Latin America, and almost 30% from Sub Saharan Africa. Taking the size of the population into account, Latin America still spend the most with 2.6 USD per capita, and Sub Saharan Africa with 1.1 USD. The largest flow of money comes from lower-middle income countries, but weighted for population, upper middle income countries has the highest expenditures. One striking finding was that Sub Saharan Africa has the highest expenditures as % of GDP, and thus can be said to have made the best effort.
Conclusion There are regional variations for what determines spending in low- and middle-income countries; overall the level of income is the most influential determinant of the spending, Except for Sub-Saharan Africa the political Stability is more important. Eastern Asia and Europe has room for improvement when it comes to national effort to respond to the HIV pandemic. Overall the governments in low- and middle-income countries spend 0.034% of their GDP on HIV and AIDS, and they only half a dollar per capita in 2004.