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  • Consistent with a similar study we found economic status to

    2021-09-17

    Consistent with a similar study, we found economic status to be very important to domestic funding of HIV. Upper-middle-income and high-income countries are more likely to have fiscal space for health and be less reliant on external sources. Moreover, richer countries often attract larger cofinancing demands from external donors. Of note, there was no sufficient evidence in our analysis to suggest an association between HIV prevalence and domestic HIV expenditure as percentage of HIV total expenditure. Mixed evidence exists in literature on the relationship between prevalence of HIV and HIV expenditure,4, 5 and thus, it warrants further investigation. In addition to budgetary allocation, there is a need for innovative financing mechanisms to improve domestic HIV expenditure in SSA. Some countries have started exploring alternative means such as earmarked levies, taxes, and debt conversion instrument, which have contributed moderately to their domestic expenditure. Undoubtedly, domestic expenditure alone cannot meet the required investment for ending HIV epidemic in SSA, but it can significantly complement international support toward achieving this goal.
    Conclusions Some countries in SSA are still overly dependent on external support for their HIV response, and income level appears to be an influential factor. For sustainability of HIV programs and to end the HIV epidemic, governments across SSA need to demonstrate stronger commitment and leadership by ensuring more domestic funding of HIV. While this may require economic growth, governments can improve their fiscal space for HIV response by looking internally for innovative and sustainable funding mechanisms.
    Author statements
    Global scale-up of services to prevent mother-to-child transmission (PMTCT) of HIV-1 has resulted in marked AICAR phosphate of vertical transmission of HIV-1 from mothers to children. The Joint United Nations Program on HIV and AIDS reported a 60% reduction in the number of children newly infected with HIV between 2009 and 2015 in 21 priority countries, with the highest burden in Sub-Saharan Africa., , It is expected that the number of new infections among children will further decrease globally as countries in this region continue to expand their PMTCT services. Globally, more than 1 million HIV-exposed uninfected children were born in 2014. Evidence suggests that HIV exposure results in higher rates of morbidity and mortality in HIV-exposed uninfected children compared with HIV-unexposed children, even when they are breastfed for some period., , Several factors are thought to contribute to this increased vulnerability in HIV-exposed uninfected children, including altered child immunity, maternal HIV-related illness, higher rates of adverse pregnancy outcomes such as preterm delivery, shorter duration of breastfeeding, and psychosocial and socioeconomic stressors among HIV-infected women., , , , , , However, no published studies to date have systematically and concomitantly examined detailed biomedical and psychosocial predictors of mortality in HIV-exposed uninfected vs HIV-unexposed children. Over the last decade, access to 3-drug (combination) antiretroviral therapy (ART) has increased dramatically, including in pregnant women. ART is expected to improve the health of HIV-positive women and potentially improve their quality of life and socioeconomic status. However, it is unknown whether higher morbidity and mortality previously observed in HIV-exposed uninfected children (compared with HIV-unexposed children) persists with improved maternal health brought about by access to ART.
    Introduction The overall prevalence of HIV infection in Brazil is estimated at 0.4%, but the epidemic is highly concentrated in vulnerable populations, with 5.3% prevalence among sex workers and 19.8% in men who have sex with men (MSM) according to the last reports. The higher risk of HIV infection among MSM may be partly explained by the practices and behaviors associated with anal sex and the gut tropism of HIV.2, 3 Besides that, behavioral vulnerabilities act together increasing the chances of HIV infection between MSM, such as no condom use, practice of transactional sex, use of drugs during sex, and sex with casual partners.