Funding None Declaration of interests br Abstract
Declaration of interests
Abstract Background Millennium Development Goal (MDG) 6 focused on halting the spread of HIV/AIDS. Since this goal was established, more development assistance for health has been devoted to combat HIV/AIDS in low-income and middle-income countries than any other cause of illness. In this study, we aim to track development assistance for the prevention and treatment of HIV/AIDS at a granular level, assessing the priorities over time for each major donor. Methods We extracted data from the Institute for Health Metrics and Evaluation\'s Financing Global Health 2015 report. This report systematically tracks development assistance for health care from 1990 to 2015, and splits this assistance into more than 20 health focus areas, drawing data from all the main international development agencies working with HIV/AIDS, including all bilateral aid agencies and the US President\'s Emergency Plan for AIDS Relief; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; the World Bank; the Gates Foundation, and the Joint United Nations Programme on HIV/AIDS. We used budget documents and project descriptions to track donors\' priorities and to categorise investments. We report the sources of the funds, primary purchase AG 013736 of delivery, and the recipient countries. Findings Since 2000, US$100·4 billion of development assistance has been provided for HIV/AIDS. In 2014, $10·9 billion was disbursed. Between 2000 and 2010, assistance for HIV/AIDS grew at an annualised rate of 23%. However, since 2010, the annualised rate of growth has been less than 1%. The US Government was the largest source of development assistance for HIV/AIDS during the MDG era, between 2000 and 2015, providing 56% of all funding. The US Government prioritised treatment (40% of its fund in 2014) and prevention (31%), whereas the Global Fund to Fight AIDS, Tuberculosis, and Malaria splits its investments between prevention, strengthening of health systems, and treatment. UNAIDS focused more than 60% of its assistance on the strengthening of health systems. Across all recipient countries, an average of $3600 per HIV/AIDS disability-adjusted life-year was disbursed between 2000 and 2014. Interpretation The scale-up of development assistance for HIV/AIDS has been both remarkable and diverse, with different agencies prioritising different investment strategies. Understanding spending patterns and comparative advantages provides insight into what agencies can contribute as the global AIDS community transitions from the MDGs to the Sustainable Development Goals. Funding Bill & Melinda Gates Foundation. Declaration of interests
Abstract Background Sexually transmitted infections (STIs) are an important health issue in developing countries. Key populations, including people living with HIV, men who have sex with men, trans women, transactional sex workers, pregnant adolescents, and migrants, are at high risk of STIs and have barriers to sexual health services. In this study, we aim to understand capacities and barriers to access for key populations in the Dominican Republic, and to identify opportunities to improve services. Methods We used purposive sampling to solicit views from stakeholders in Santo Domingo, Dominican Republic, including health-care agencies, community-based organisations, and government entities that guide STI screening policy. We conducted 19 semi-structured interviews between February, 2015, and May, 2015, with: nine health providers, seven community leaders, and three government authorities, asking questions about STI services for key populations, gaps in services, and barriers to access. Comprehensive notes and audio recordings were iteratively reviewed by two investigators to define barriers and opportunities for STI screening. Findings Respondents identified barriers to access at individual, community, organisational, and policy levels. Individual barriers include poor risk perception and health knowledge, drug use in transactional sex workers and trans women, inability to negotiate condom use in sex worker and adolescent groups, and poverty. Community barriers include: discrimination against sex workers, trans women, people living with HIV, men who have sex with men, and migrants; and a culture of self-medicating in all populations. Organisational barriers include a lack of centres offering STI testing, unavailability of medications in centres accessed by key population, and poor knowledge of available resources in the community. Policy barriers include poor access to insurance in populations; low resource allocation to STIs, other than HIV; and inconsistent supply of materials and funds. Despite these barriers, local organisations that work with key populations expressed interest in increasing capacity to screen and treat STIs.