The Fiscal Dimension of HIV/AIDS in
            Botswana, South Africa, Swaziland, and Uganda

Lule, Elizabeth; Haacker, Markus

The Fiscal Dimension of HIV/AIDS in Botswana, South Africa, Swaziland, and Uganda

Autores

Lule, Elizabeth

Haacker, Markus

Editor

World Bank

Descripción

HIV/AIDS imposes enormous economic, social, health, and human costs and will continue to do so for the foreseeable future. The challenge is particularly acute in Sub-Saharan Africa, home to two-thirds (22.5 million) of the people living with HIV/AIDS globally, and where HIV/AIDS has become the leading cause of premature death. But now, after decades of misery and frustration with the disease, there are signs of hope. HIV prevalence rates in Africa are stabilizing. This book sheds light on these concerns by analyzing the fiscal implications of HIV/AIDS in Southern Africa, the epicenter of the epidemic. It uses the toolbox of public finance to assess the sustainability of HIV/AIDS programs. Importantly, it highlights the long-term nature of the fiscal commitments implied by HIV/AIDS programs, and explicitly discusses the link between HIV infections and the resulting commitments of fiscal resources. The analysis shows that, absent adjustments to policies, treatment is not sustainable. But it also shows that, by accompanying treatment with prevention, and making existing programs more cost-effective, these countries can manage both treatment and fiscal sustainability. Even in countries where HIV/AIDS-related spending is high or increasing (as past infections translate into an increasing demand for treatment), the fiscal space absorbed by the costs of HIV/AIDS-related services will decline if progress in containing and rolling back the number of new infections can be sustained. The purpose of this study is to refine the analysis of the fiscal burden of HIV/AIDS on national governments and assess the fiscal risks associated with scaling-up national HIV/AIDS responses. The study complements and contributes to the agenda on identifying and creating fiscal space for HIV/AIDS and other development expenditures. The findings from this study, and the analytical tools developed in it, could help governments in defining policy objectives, improving fiscal planning, and conducting their dialogue with donor agencies.

Palabras clave

ABSENTEEISM, ACQUIRED IMMUNODEFICIENCY SYNDROME, AFFECTED COMMUNITIES, AIDS EPIDEMIC, AWARENESS CAMPAIGNS, BEHAVIOR CHANGE, CLIMATE, COMMERCIAL SEX, COMMERCIAL SEX WORKERS, COMMUNITIES, COMMUNITY ACTION, COMMUNITY PARTICIPATION, COUNCILS, DECENTRALIZATION, DECISION-MAKING, DEVELOPMENT PROCESS, DISCRIMINATION, DRUG USERS, EDUCATION, EFFECTIVE PREVENTION, EXERCISES, EXPENDITURE, FAMILIES, GENDER EQUALITY, GIRLS, GOVERNMENT AUTHORITY, GOVERNMENT LEVEL, GOVERNMENT ROLES, HEALTH, HEALTH CARE, HEALTH SERVICES, HIV, HIV POSITIVE, HOUSING, HUMAN IMMUNODEFICIENCY VIRUS, HUMAN RESOURCES, IDEAS, IMMUNODEFICIENCY, INCOME, INTERVENTION, LABOR PRODUCTIVITY, LABOR SUPPLY, LEADERSHIP, LEVELS OF GOVERNMENT, LOCAL AUTHORITIES, LOCAL GOVERNMENT, LOCAL GOVERNMENT AUTHORITIES, LOCAL GOVERNMENTS, MANAGERS, MEDIA, MINISTRIES OF HEALTH, MUNICIPAL MANAGEMENT, MUNICIPALITY, NATIONAL AIDS COUNCILS, NATIONAL GOVERNMENTS, NATIONS, ORPHANS, PARTNERSHIP, PATIENTS, PRIMARY HEALTH CARE, PRIVATE SECTOR, PUBLIC HEALTH, REPRESENTATIVES, RESOURCE MOBILIZATION, RISK FACTORS, SERVICE DELIVERY, SEX WORKERS, SOCIAL WELFARE, SOCIETY, TRANSMISSION, UNAIDS, URBAN AREAS, VOLUNTARY COUNSELING, VULNERABLE CHILDREN, ACQUIRED IMMUNE DEFICIENCY SYNDROME, HIV VIRUSES, EPIDEMICS, HANDBOOKS, COMMUNITY PARTICIPATION, LOCAL GOVERNMENT, LOCAL NONGOVERNMENTAL ENTITIES, CIVIL SOCIETY, GOVERNMENT ROLE, GOVERNANCE CAPACITY, INTERAGENCY COORDINATION, DISEASE PREVENTION & CONTROL, RESOURCES MOBILIZATION, MONITORING CRITERIA