Austerity, and funding cuts: Implications for sustainability of the response to the Caribbean HIV/AIDS epidemic

ABSTRACT

The Caribbean, accessed significant external funding over the first three decades of the epidemic, which provided local authorities the opportunity to defer their responsibility in leading or matching the support provided from the external agencies. The reduction in external support has placed increased pressure on the response to the epidemic, with some countries more likely to be affected than others. This paper undertakes a review of the expenditure and funding landscape for HIV programs in the Caribbean. The findings confirm that despite the dwindling number of funding sources, some countries continue to display a significant degree of dependency on external funding sources. It is noteworthy that Treatment and Care accounted for the largest share of HIV expenditure in those countries, which displayed the highest degree of dependency on external funding. While, HIV spending was a relatively small percentage of both total health expenditure and gross domestic product, expenditure levels were noticeably higher in Haiti. These averages however conceal significant differences across countries, which should inform the magnitude and direction of any spending expansion by these countries if they are to achieve financial sustainability. Some recommendations are provided on the way forward to facilitate building a sustainable response to the epidemic.

KEYWORDS:

• HIV
• Caribbean
• sustainability
• health expenditure

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

1 Guyana and Suriname sit on the South American Continent and have large land masses with small populations.

2 According to ECLAC (2018), 11 of 15 English speaking Caribbean countries recorded a debt to GDP ratios of over the 60% threshold identified by the Work bank as critical.