THE GLOBAL IMPACT OF HIV/AIDS has devastated millions of lives and has resulted in major reversals in health outcomes in a number of countries.1 By 2009, an estimated 33 million people were living with HIV, 1.8 million died in that year, and 16 million young people had lost at least one parent because of the epidemic.2 Compounding the challenges posed by the epidemic is the fact that it is distributed unevenly geographically, with 70 percent of people living with HIV/AIDS located in Africa, and 44 percent (14.6 million) in just 12 African countries with a combined population of 224 million people (3 percent of the global total).3
The serious health impacts of the epidemic, combined with the fact that many people living with HIV/AIDS are located in low-income countries, have also motivated concerns that the epidemic is undermining development more generally, reinforcing the economic disadvantages of these countries. These concerns, in turn, have strengthened the impetus behind the global policy response to HIV/AIDS. The available evidence on the economic development impacts of HIV/AIDS thus fulfills a political role. In this setting, "policy" and "analysis" can be interpreted as interdependent-the supply of analytical work underlining the economic development impacts of HIV/AIDS feeds the needs of policy and advocacy, while the needs of policy and advocacy create a demand for supportive analytical work.
The paper sets out with a discussion of how major international policy documents have adopted and built on statements on the adverse economic development impact of HIV/AIDS. This is contrasted with an analysis of the available studies of the impact of HIV/AIDS on economic growth and studies addressing the implications of HIV/AIDS for the affected households and for poverty more generally. This review finds that the literature in both areas is unconvincing. Empirical evidence of the growth impacts of HIV/AIDS is weak, and there is some evidence of policy-induced bias among studies modeling the growth impacts of HIV/AIDS. While some data are available of the immediate impacts of HIV/AIDS on affected households, the evidence on the impacts over time and across households, and thus the understanding of the impacts of HIV/AIDS on poverty, is much weaker. The paper concludes by a discussion of casting HIV/AIDS as an economic development challenge, placing more emphasis on increased economic and health risks, and makes some points on better aligning the response to HIV/AIDS with the international development agenda.
Presenting HIV/AIDS as an Economic Development Challenge
The perception of HIV/AIDS as an economic development challenge is important not only in gaining a full understanding of the impacts of the disease, but also in soliciting political and financial support for the response to the epidemic. Sir George Alleyne, Director Emeritus of the Pan American Health Organization (PAHO), underlines the "role of health as an instrument for human development" in "persuading finance ministers to spend money." UNAIDS Executive Director Michel Sidibé emphasizes the need to "link HIV to the broader international health and development agenda, as represented by the MDGs [Millennium Development Goals] ... to sustain and accelerate progress in the next phase of the global response to AIDS."4
The impact of HIV/AIDS has commanded a prominent place in the international development agenda, especially over the last decade. The United Nations Millennium Declaration of 2000, as part of the agenda to create an environment "which is conducive to development and to the elimination of poverty," resolved to halt and reverse "the spread of HIV/AIDS, the scourge of malaria and other major diseases that afflict humanity," and "to provide special assistance to children orphaned by HIV/AIDS."5 The 2006 UN Political Declaration states "that in many parts of the world, the spread of HIV/AIDS is a cause and consequence of poverty, and that effectively combating HIV/AIDS is essential to the achievement of internationally agreed development goals and objectives, including the Millennium Development Goals. …