In 2008, total U.S. philanthropic support for HIV/AIDS increased by 11% to $618 million, primarily due to the Bill & Melinda Gates Foundation, which alone accounted for 59% of funding. The majority of disbursements (84%) were directed to international efforts, emphasizing a concentration of funds among a small number of donors. However, projections for 2009 indicate anticipated decreases in funding levels, raising concerns about sustaining support for critical HIV/AIDS services amidst a global economic downturn.