Structural adjustment and the spread of HIV/AIDS

This paper evaluates the arguments that economic policy advice from the international financial institutions - particularly the International Monetary Fund and the World Bank - has contributed to the spread of HIV/AIDS. Focusing mainly on sub-Saharan Africa, the paper gives some background information on the structural adjustment programmes (SAPs) in which this policy advice is embodied, surveys those writings that argue that these programmes are contributing to the spread of HIV/AIDS and then the repsonses to them. It discusses the difficulties of measuring the impact of discrete economic variables on the transmission of HIV and the importance of not confusing correlation with causality in judging the effects of SAPs. While understanding the causal impact of economic policies on HIV transmission might be difficult, the paper concludes that there are still reasons to build into SAPs an ex ante assessment of their possible impact on HIV transmission. There is a growing amount of evidence that HIV/AIDS depresses economic growth, disrupts civil society, contributes to declining standards of governance and reduces countries' ability to meet debt repayment obligations. These are all structural conditions that need to be adjusted.