October 7, 2011
Socioeconomic obstacles to HIV prevention and treatment in developing countries:
the role of the International Monetary Fund and the World Bank
Peter Lurie, Percy Hintzen and Robert A. Lowe
Argue: social and economic forces have also played a critical role in promoting the
spread of HIV.
Failure to consider all aspects of HIV may be inhibiting our ability to reduce the spread
of HIV infection.
HIV highest in urban centers, along trade routes, among commercial sex workers and
among male migrant workers.
Macroeconomic measures: evaluate national economic performances using indicators
such as GNP, employment rate and inflation rate.
o This approach (in 1980s) is spearheaded y International Monetary Fund (IMF)
and the World Bank, may have created conditions favouring the spread of HIV.
The historical origins of structural adjustment programs
1950s and 1973, growth in economics of industrialized nations increased demand for
exports. Expansion of economy – developing countries emulated social policies,
providing government support for health, education and welfare programs.
1970s: hit to economy in early 1970s – Organization of Petroleum-Exporting Countries
oil embargo of 1973 quadrupled oil prices. Increased cost of exports, lowered the
o Developing countries: excess of imports, mountains of debts.
o Borrow money.
o IMF, the world bank, agents, etc. set similar preconditions for all forms of
international credits. Poorer countries forced to enter structural adjustment
o SAP gave them little choice other than to drastically restructure their economies
along their guidelines.
The characteristics of SAP
1) concessions to foreign investors, including tax incentives and tariff elimination
2) economic and trade liberalization, often exposing developing country producers to
competition from imported goods
3) stimulation of economic activity directed toward export rather than toward domestic
4) currency devaluation leading to higher prices for imported goods
5) curbs on consumption in developing countries by making loans more expensive and less
6) increases in the prices of goods and services to bring them in line with world market
7) personal income and consumption tax increases
8) reduction in government spending, including cutbacks in health and social services.
stimulate growth of private and export sectors in developing countries.
Recent years: become more involved in health care issues – HIV prevention and treatment.
Criticized as too late and limited in scope and reliant on private sector.
October 7, 2011
The impact of SAP on the HIV epidemic
1) declining sustainabilit