World Bank in AIDS prevention controversy

James JS
Publication Year:
AIDS TREATMENT NEWS. 1995 Jun 16; (225):7-8.

Despite World Bank protest, an editorial review was published in the British Journal AIDS critical of World Bank- and International Monetary Fund-imposed structural adjustment programs. The authors, researchers at the University of California’s Center for AIDS Prevention Studies, argue that structural adjustment programs imposed upon developing countries since the early 1980s may have created conditions which favor the spread of HIV infection in developing countries. In the attempt to control inflation and redirect production toward exports, these programs also greatly increased individual and national hardship, including the reduction of public services. The article is particularly concerned about the following alleged consequences of structural adjustment: the decline of the rural subsistence economy, forcing rural-urban migration in search of employment; the development of a transportation infrastructure, through which HIV spreads; migration and urbanization; and reduced spending upon health and social services. The authors recommend specific changes in development programs. Far from the condemnation received by the World Bank, both the authors of the article and the management of AIDS deserve considerable credit for bringing this problem to light. Almost all AIDS prevention activity has focused upon getting individuals to change their behavior. The AIDS review has instead provoked thought about the potential need for institutional change as well in preventing HIV infection and AIDS. Reform is, however, unlikely since institutions are loathe to acknowledge having any responsibility for the health consequences of their actions.