Abstract
ObjectiveWe assessed HIV/AIDS expenditures in Dehong Prefecture, Yunnan Province, one of the highest prevalence regions in China, and describe funding sources and spending for different categories of HIV-related interventions and at-risk populations.Methods2010 HIV/AIDS expenditures in Dehong Prefecture were evaluated based on UNAIDS’ National AIDS Spending Assessment methodology.ResultsNearly 93% of total expenditures for HIV/AIDS was contributed by public sources. Of total expenditures, 52.7% was allocated to treatment and care, 24.5% to program management and administration and 19.8% to prevention. Spending on treatment and care was primarily allocated to the treatment of opportunistic infections. Most (40.4%) prevention spending was concentrated on most-at-risk populations, injection drug users (IDUs), sex workers, and men who have sex with men (MSM), with 5.5% allocated to voluntary counseling and testing. Prevention funding allocated for MSM, partners of people living with HIV and prisoners and other confined populations was low compared to the disproportionate burden of HIV/AIDS in these populations. Overall, people living with HIV accounted for 57.57% of total expenditures, while most-at-risk populations accounted for only 7.99%.ConclusionsOur study demonstrated the applicability of NASA for tracking and assessing HIV expenditure in the context of China, it proved to be a useful tool in understanding national HIV/AIDS response from financial aspect, and to assess the extent to which HIV expenditure matches epidemic patterns. Limited funding for primary prevention and prevention for MSM, prisoners and partners of people living with HIV, signal that resource allocation to these key areas must be strengthened. Comprehensive analyses of regional and national funding strategies are needed to inform more equitable, effective and cost-effective HIV/AIDS resource allocation.
Highlights
A joint surveillance effort undertaken by the China Ministry of Health, UNAIDS, and WHO in 2011 estimated that there are currently 780,000 (0.058%) individuals living with HIV/AIDS inChina, with the majority having been infected through heterosexual contact (46.5%), followed by injection drug use (IDU) (28.4%), male homosexual contact (17.4%), contaminated blood product (6.6%), and mother-to-child transmission (1.1%)
An estimated 52.6% of total expenditures was allocated to HIV treatment and care, followed by 24.5% to program management and administration, 19.8% to HIV prevention, human resources (2.75%), Social protection and social services (0.29%), Orphans and vulnerable children (OVC) (0.09%), Enabling environment (0.05%) and HIV-related research (0.01%)
Inpatient treatment of opportunistic infections accounted for the majority (42.1%; $ 1499853.31) of all spending on treatment and care, followed by antiretroviral therapy (30.4%; $ 1084104.53), outpatient prophylaxis and treatment of opportunistic infections (8.17%; $290940.38), provider-initiated testing and counseling (PITC) (2.15%; $76424.35), specific HIV-related laboratory monitoring (12.60%; $448852.37) and psychological treatment and support services (2.45%; $87178.41)
Summary
A joint surveillance effort undertaken by the China Ministry of Health, UNAIDS, and WHO in 2011 estimated that there are currently 780,000 (0.058%) individuals living with HIV/AIDS inChina, with the majority having been infected through heterosexual contact (46.5%), followed by injection drug use (IDU) (28.4%), male homosexual contact (17.4%), contaminated blood product (6.6%), and mother-to-child transmission (1.1%). Given the rapidly growing national HIV/AIDS epidemic, which demands significant expansion of HIV treatment and prevention efforts, the government has confronted new concerns related to funding and resource allocation for HIV/ AIDS. Efforts to assess whether current funding for HIV/AIDS is being allocated effectively and cost-effectively and is sufficient to meet growing treatment and prevention needs are urgently needed, among specific sub-populations at risk and in the regions most affected by the HIV/AIDS epidemic. Systematic evaluations of HIV/AIDS expenditures in China that include both health and non-health related expenditures have yet to be reported in the peerreviewed literature. These data are needed to inform both future funding strategies and cost-effectiveness analyses that can guide decision-making in HIV/AIDS resource allocation
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