SOC309Y1 Chapter Notes -Seroconversion, Informal Sector, International Monetary Fund
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 sustainability of the rural subsistence economy
a. people find them facing stiff competition (e.g. small farmers and crafts people)
decline in local income due to lower demand.
b. Rural population become cheap labour pol. Forces people to look for work
elsewhere migration patterns linked to spread of HIV.
c. Decline in food sufficiency, may contribute to declines in nutritional status,
increase risk for HIV seroconversion.
2) development of a transportation infrastructure
a. Networks connecting outlying areas to export centers developed. Connect rural
to urban centers with HIV prevalence. Facilitate spread of HIV.
3) migration and urbanization
a. Structural adjustment and other development programs may contribute to
increasing HIV risk behaviour by promoting urbanization (due to SAP).
b. Migration trends
i. Women and men away from partners may take on other partners,
increase HIV risks.
c. Commercial sex work – children not funded for education (e.g. Brazil), forced to
go into informal work sector
4) reductions in spending on health and social services
a. tax reductions and other concessions to foreign investors have decreased
government revenues in developing countries.
b. Hard to launch effective campaign to reduce high risk behaviours or to provide
resources such as condoms and sterile needles.
c. High rates of illiteracy further reduce effectiveness of HIV prevention programs.
d. Decreased access to health services.
e. Treatment resources = scarce.
Toward an alternative development strategy
need for social and economic interventions in stemming spread of HIV and treating
For developing countries – economic policies that may have promoted the spread must
o Satisfaction of basic human needs – food, housing, transportation must be
Accomplish by reduce military and luxury commodities.
Reduce hours away from home (for truck drivers/those away from
Marginal producers and subsistence farmers must be supported – don’t
look for work in urban areas.
o Greater emphasis on human resource development.
o Charters of IMF and world bank to be altered to permit the cancellation or
rescheduling of debt.
Should have parties explicitly stipulate the potential impact of the
proposed loan on HIV transmission.
The epidemic of HIV-1 and AIDS in Africa must be understood socially, in its historically
specific context, or not at all.