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The Fiscal Dimension of HIV/AIDS in Botswana, South Africa, Swaziland, and Uganda


  • Elizabeth Lule
  • Markus Haacker


HIV/AIDS imposes enormous economic, social, health, and human costs and will continue to do so for the foreseeable future. The challenge is particularly acute in Sub-Saharan Africa, home to two-thirds (22.5 million) of the people living with HIV/AIDS globally, and where HIV/AIDS has become the leading cause of premature death. But now, after decades of misery and frustration with the disease, there are signs of hope. HIV prevalence rates in Africa are stabilizing. This book sheds light on these concerns by analyzing the fiscal implications of HIV/AIDS in Southern Africa, the epicenter of the epidemic. It uses the toolbox of public finance to assess the sustainability of HIV/AIDS programs. Importantly, it highlights the long-term nature of the fiscal commitments implied by HIV/AIDS programs, and explicitly discusses the link between HIV infections and the resulting commitments of fiscal resources. The analysis shows that, absent adjustments to policies, treatment is not sustainable. But it also shows that, by accompanying treatment with prevention, and making existing programs more cost-effective, these countries can manage both treatment and fiscal sustainability. Even in countries where HIV/AIDS-related spending is high or increasing (as past infections translate into an increasing demand for treatment), the fiscal space absorbed by the costs of HIV/AIDS-related services will decline if progress in containing and rolling back the number of new infections can be sustained. The purpose of this study is to refine the analysis of the fiscal burden of HIV/AIDS on national governments and assess the fiscal risks associated with scaling-up national HIV/AIDS responses. The study complements and contributes to the agenda on identifying and creating fiscal space for HIV/AIDS and other development expenditures. The findings from this study, and the analytical tools developed in it, could help governments in defining policy objectives, improving fiscal planning, and conducting their dialogue with donor agencies.

Suggested Citation

  • Elizabeth Lule & Markus Haacker, 2012. "The Fiscal Dimension of HIV/AIDS in Botswana, South Africa, Swaziland, and Uganda," World Bank Publications, The World Bank, number 2382, March.
  • Handle: RePEc:wbk:wbpubs:2382

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    References listed on IDEAS

    1. Tobias N. Rasmussen, 2004. "Macroeconomic Implications of Natural Disasters in the Caribbean," IMF Working Papers 04/224, International Monetary Fund.
    2. Armstrong, J., 1995. "Uganda's AIDS Crisis. Its Implications for Development," World Bank - Discussion Papers 298, World Bank.
    3. Bogomolova, Tatiana & Impavido, Gregorio & Pallares-Miralles, Montserrat, 2006. "An assessment of reform options for the public service pension fund in Uganda," Policy Research Working Paper Series 4091, The World Bank.
    4. Tim Allen & Suzette Heald, 2004. "HIV|AIDS policy in Africa: what has worked in Uganda and what has failed in Botswana?," Journal of International Development, John Wiley & Sons, Ltd., vol. 16(8), pages 1141-1154.
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    Cited by:

    1. Sterck, Olivier, 2016. "Natural resources and the spread of HIV/AIDS: Curse or blessing?," Social Science & Medicine, Elsevier, vol. 150(C), pages 271-278.


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