The National AIDS Spending Assessment (NASA) 2019 -2021 results show that total expenditure on HIV and AIDS interventions in Zambia increased moderately from Four hundred and fifty million, two hundred and ninety-seven thousand, four hundred and fifty-three United States Dollars (USD$450, 297, 453) in 2019; Four hundred and ninety-four million, three and forty-nine thousand, nine hundred and eighty-one United States Dollars (USD$ 494, 349, 981) in 2020; and Five hundred and four million, four hundred and twelve and sixty-five United States Dollars (USD$ 504, 412, 065) in 2021, representing an increase of 10 per cent in 2020 and two per cent (2%) in 2021. Total expenditure over the three-year period amounted to One billion, four hundred and forty-nine million, fifty-nine thousand, four hundred and ninety-nine United States Dollars (USD$ 1, 449, 059, 499). From 2019 to 2021, the increase rate in expenditure on the HIV and AIDS response was 12 per cent. Considering the future resource requirements to combat the two diseases, increasing levels of funding are required to contain and maintain epidemic control. The HIV and TB pandemics require long-term, forward-looking, sustained investments, leadership and political commitment. Therefore, the National AIDS Spending Assessment (NASA) has allowed us to prove the worth of our combined efforts in aiding Zambia in achieving its strategic focus area of eliminating AIDS and tuberculosis by 2030. Through this NASA, previously unknown gaps and priorities have been identified, allowing us to better allocate our resources and close the gap between underserved communities. The national response to HIV and AIDS in Zambia depends essentially on two external donors: the United States of America Government (USG) and the Global Fund (GF). During the period 2019 to 2021, the United States of America (USA) contributed 76.32 per cent of national HIV and AIDS expenditure followed by the Global Fund with 17.32 percent. The contributions of these two donors alone amounted to 91.75 percent in 2019, 91.37 percent in 2020, and 89.35 percent in 2021.

The protection and promotion of human rights and gender equality for people living with HIV, vulnerable populations and key populations, including young key populations, is critical to successful responses to HIV, TB and sexual and reproductive health. Zambia has signed and ratified a number of international and regional human rights treaties that commit to protecting the rights of all persons, particularly vulnerable populations; Zambia also includes the protection of human rights as a central tenet of its national Constitution. The Constitution provides all persons with the right to equality and non-discrimination, life, privacy, liberty, association and assembly, health, fair labour practices, social protection and freedom from torture or degreated treatment, amongst other things; these rights are important for people in the context of health, human rights and gender equality. In addition, Zambia has enacted a number of laws, policies, strategies, guidelines and plans that further protect the rights of all persons, some of which are specific to the context of health, HIV and vulnerable and key populations. National health, sexual and reproductive health, HIV, TB, youth and gender laws and policies recognise the importance of rights-based development responses that provide for the health of all persons, regulate the professional and ethical conduct of health workers and other service providers, reduce stigma and discrimination and create an enabling framework to reduce human rights and gender-related barriers to the health and well-being of all people. Some HIV-specific policies and guidelines, such as HIV testing and counselling policies and workplace HIV policies, provide detailed protection for the rights of people in the context of HIV and AIDS, including the rights to HIV testing and treatment only with voluntary and informed consent, confidentiality and nondiscrimination in the workplace. National laws, policies, strategies and plans also recognise the needs of vulnerable and key populations such as women, children and young people and, in some cases, key populations. Young people’s rights to access

HIV allocative efficiency studies are generally posing the question “How can HIV funding be optimally allocated to the combination of HIV response interventions that will yield the highest impact?”. In this context the government of Zambia approached the World Bank with a request to conduct an allocative efficiency analysis to inform the revised national AIDS strategic framework (R-NASF), prioritisation of the HIV response, and value for money considerations in the context of resource mobilisation. Four main policy questions were posed: (1) What are the estimated and projected HIV epidemic trends until 2030 and the transmission dynamics between sub-populations? (2) What is the optimised HIV resource allocation to minimise HIV incidence and AIDS mortality between 2014 and 2030? (3) What is the minimum spend required to meet moderate or ambitious national strategic impact targets? (4) What are the long-term financial commitments of HIV treatment and healthcare costs? Zambia, recently reclassified as a low- and middle-income country (LMIC), had an estimated total population of 14.08 million in 2012. The country enjoys positive annual GDP growth—at 6.4% in 2013—and a fairly stable macroeconomic situation. Nevertheless, income levels are highly skewed and in 2010, 60.5% of the population were living below the national poverty line, which impacts negatively on health.