Coping with the Impact of AIDS

• Author: Mead Over
• Position: Senior Economist in the Development Research Group of the World Bank. He is co-author of Confronting AIDS: Public Priorities in a Global Epidemic
• Pages: 22-24

The AIDS epidemic is straining the limited resources available to many developing country governments. How can governments provide support to those affected by AIDS without neglecting others in need or abandoning important development goals?

Page 22

WHILE SOME countries still have the opportunity to avert a full-blown AIDS epidemic, others are already confronting widespread HIV infection. What can be done to help people with AIDS in developing countries? What will be the impact of AIDS morbidity and mortality on health systems, on poverty, and on developing economies generally? And what should governments do to mitigate that impact?

Many societies consider it a priority to help those who are disadvantaged from birth-the poor and the handicapped- or those who suffer some calamity during their lifetime. While people with HIV/AIDS clearly fall into the second category, equity considerations and budgetary constraints suggest that any given society should treat HIV/AIDS the same way it treats the problems of sickness, poverty, and vulnerability more generally. Governments should be guided by two propositions in their efforts to alleviate the suffering caused by the AIDS epidemic.

First, all patients suffering from illnesses for which treatment does not affect transmission, regardless of cause, should be equally eligible for public assistance. Thus, a patient suffering from terminal cancer should have the same right to public support as an HIV-infected patient. This leaves open the question of how much of the cost of treatment should be covered by public funding. The standard arguments (externalities, public goods) for public subsidies do not apply here: the benefits of treatment accrue almost entirely to the individuals being treated. Nevertheless, other arguments-compassion, society's moral responsibility to its less fortunate members, the belief that health or health care is a basic need-typically support substantial public subsidies for the sick. This has significant implications for an overall approach to the HIV/AIDS epidemic.

Second, governments should focus on helping equally poor people equally, regardless of the cause of their poverty. Research in Kagera, Tanzania, finds that the death of an adult from AIDS depresses per capita food consumption in the poorest households by 15 percent-but this is not much different from the effect of adult deaths from other causes. Children in AIDS-stricken households are malnourished and drop out of school, resulting in serious long-term harm-but children in other poor households suffer the same fate. Thus, an adult death (from whatever cause) may be useful as an additional indicator that a household needs help, but, in the interests of equity, a death should not by itself trigger government antipoverty assistance.

Impact...