Making AIDS Part of the Global Development Agenda

• Author: Robert Hecht, Olusoji Adeyi, and Iris Semini
• Position: Senior Adviser to the Vice-President for Human Development at the World Bank and previously served as Associate Director at the Joint United Nations Program on HIV/AIDS (UNAIDS)/Senior Health Specialist and Focal Point for HIV/AIDS in the Europe and Central Asia Region of the World Bank/Technical Officer on Poverty, Debt, and AIDS at UNAIDS

AIDS is not just a health issue but a development problem that must be addressed at the global level. As countries increasingly recognize the need to incorporate strategies for tackling AIDS in their national policy frameworks, they are discovering important new weapons-notably national poverty reduction plans-that were not available even two years ago.

In the past two years, development thinking has undergone a major shift, from viewing AIDS as purely a health issue to acknowledging that it must be tackled as part of a broader development agenda. There is evidence of this new approach, referred to as "mainstreaming," at the highest levels of development policy and assistance. At a meeting of the Development Committee of the World Bank and the IMF in April 2001, ministers called for focusing on HIV/AIDS in development policies and increasing assistance to affected countries. Developing countries themselves have announced their intention of making AIDS a mainstream issue, most visibly in June 2001 during the United Nations General Assembly Special Session on HIV/AIDS.

Why is this shift in thinking so important? HIV/AIDS takes a heavy toll, both economic and human, as it undermines productivity, security, education, health care, civil service systems, social cohesion, and political stability. It is shortening the life expectancy of working-age adults, dramatically increasing the numbers of infant and child deaths, shrinking the workforce, creating tens of millions of orphans, widening the gap between rich and poor, and reversing development gains. Since the onset of the epidemic, almost 22 million people worldwide have died of AIDS, and another 36 million people are living with the HIV virus. In Africa alone, 12 million men, women, and children-more than the entire population of Belgium-have died to date.

Developing countries that do not, or cannot, protect human capital-the education and skills embodied in people that enable them to increase their future incomes-will not be able to participate fully in the global economy, much less take advantage of the opportunities it affords. Smallholder farm families in Zimbabwe experience a 40-60 percent fall in the production of maize, peanuts, and cotton after suffering an AIDS death. Children who lose a parent to AIDS in rural Tanzania are about 50 percent more likely to be malnourished than children from families with both parents living. Data from over 15 African and Latin American countries also show that children who lose both parents to AIDS are much less likely to continue attending school. A recent World Bank study estimates that Africa's income growth per capita is being reduced by about 0.7 percent a year because of HIV/AIDS.

Moreover, although AIDS is not exclusively a disease of the poor, much evidence suggests that certain poor groups run a disproportionately greater risk of becoming infected with the HIV virus. In many countries, infections are heavily concentrated among injecting drug users and their partners and among...