The financial crisis that started in the most-developed economies has become a global economic crisis which threatens gains in health and poverty reduction in developing countries. Advanced economies are projected to suffer deep recessions in 2009, with their gross domestic product (GDP) contracting by 5% on average—the first such fall in 60 years. This is generating fears that official development assistance, and in particular resources for social sector spending, including funding for HIV services and commodities, would remain flat during the next few years.
The feedback loop between a corrosive financial sector and declining economic activities has spilled over to developing countries. Their economic growth is expected to slow sharply, from 6.1% in 2008 to 1.6% in 2009. Many households may experience increased mortality and morbidity if the commitments pledged by the international community to sustain and increase access to antiretroviral treatment are not honoured and/or government expenditures on AIDS are reduced. Even temporary interruptions in treatment access can have long-term effects which are costly to reverse. This is discussed in Section I, which outlines the risks to AIDS programmes and the impacts that may result from the crisis.
Are they likely to occur? To find out, a survey of UNAIDS, WHO and World Bank staff in 71 countries was carried out in March 2009. The results of the survey are combined with technical information on treatment and drug resistance and the World Bank Country Policy and Institutional Assessment database to identify risk profiles for national AIDS programmes and to propose some appropriate responses by countries and international partners. The analysis in Section II attempts to identify which AIDS programmes are most exposed to the current crisis. Section III discusses whether the exposed countries have the means to respond to the crisis and concludes with recommendations for the international community and vulnerable countries.
Contents
Acknowledgements
Abbreviations
Executive summary
Introduction
AIDS programmes and risks
- Treatment risks
Prevention risks
Perceptions of vulnerability of treatment and prevention programmes
- Perceived impact on antiretroviral treatment
Vulnerability of prevention programmes
Countries’ exposure to the global crisis
- Most-exposed countries
Less-exposed countries
Least-exposed countries
Role of external financing
Countries’ capacity to respond
Implications: innovation and action
- References
List of boxes
Box 1: Survey of the impact of the economic crisis on antiretroviral treatment and prevention (March 2009)
- Box 2: What are the characteristics of programmes that are well protected?
Box 3: How do countries adjust? The case of a Caribbean country
Box 4: Type of impact on countries’ AIDS programmes reported
Box 5: Examples of reported impact on prevention programmes
Box 6: Country Policy and Institutional Assessments (CPIA) by the World Bank
Box 7: Types of assistance needed, as identified in the survey
List of figures
- Figure 1: Adverse Impact on treatment to date and in the next 12 months
Figure 2: Percentage of people on treatment in the countries which could be affected in
the next 12 months
Figure 3: Adverse impact on prevention
Figure 4: Economic crisis and HIV
Figure 5: External financing for antiretroviral treatment
List of tables
- Table 1: Classification of exposed programmes by funding source, size of AIDS burden
and external shock to country economy 1
Table 2: Affected countries’ ratings of fiscal and institutional capacity
