¹û¶³Ó°Ôº

Dr Roberto De Vogli, the ¹û¶³Ó°Ôº Department of Epidemiology, assesses the impact of these recommended reforms - such as trade liberalisation, user-charges for healthcare and reduction of subsidies for agriculture and food (known as adjustment policies) - which often come tied up with IMF and World Bank development loans. Dr. De Vogli's work suggests that these policies, intended to promote international competitiveness and growth, inadvertently fail in their aims and can produce adverse health effects among vulnerable populations.

Recommended adjustment policies include currency devaluation and the removal of food subsidies which, De Vogli argues, can often lead to an increase in the prices for basic items such as food. In Zambia, after the removal of subsidies in 1985, the price of maize meal rose by 50%. This price increase reduces access to food, shelter, and basic commodities by women and children. The deprivation increases the exposure of women to commercial sex that in turn increases the exposure of infants to mother-to-child HIV transmission.

Other suggested reforms, such as user-charges for health services reduce access of women and youths to HIV-related prevention and identification services, such as AIDS education, condoms, HIV testing, and treatment of sexually transmitted infections (STIs).

This review, the first to analyse existing literature to show possible links between IMF and World Bank policies and the increased vulnerability of women and children to HIV/AIDS in Sub-Saharan Africa, is part of a growing body of literature looking for solutions to the economic and health crises in Africa. The review analysed an extensive body of literature - including reports by UNICEF, MEDNET, the National Bureau of Economic Research and the International Labour Organisation as well as policy reports from the IMF and the World Bank - to draw its conclusions and suggest next steps.

Dr. De Vogli said: "Our review of the literature that is out there suggests urgent changes are needed to IMF and World Bank adjustment policies. The report concludes that IMF and World Bank policies should, at least, always be accompanied by measures to protect those most at risk. We recognise that there is a requirement for public scrutiny of the social effects of the current policies. A thorough scientific analysis - that is not skewed by factors such as war and environmental disasters - is now needed. In addition to this, economists need to be encouraged to look at social aspects of economic change and health researchers need to adopt a broader approach in their evaluation of the spread of the epidemic HIV in the developing world."

Key facts:

• 19.2 million women and 3.2 million children aged less than 15 years are living with HIV/AIDS in the world. Almost two-thirds of them reside in sub-Saharan Africa. (Please see notes for editors point 2 for source information) (7)
• A World Bank study of 26 African countries that implemented adjustment policies concluded that six countries had a large improvement in macroeconomic indicators, nine had a small improvement, and 11 had a deterioration. (3)
• Africa's external debt increased from US$ 120 billion in 1980 to US$ 340 billion in 1995. (14)
• In Zambia, after the removal of subsidies in 1985, the price of maize meal rose by 50%. (26) In the same country, currency devaluation increased the cost of bread from 12 kwacha a loaf in 1990 to 350 kwacha in 1993. (21)
• In Zimbabwe, after eliminating food subsidies, the cost of living for lower-income urban families rose by 45% between mid-1991 and mid-1992. (27)
• In Nigeria, 85% of rural farmwomen reported reducing the number of meals per day in the household from three to two after the implementation of the adjustment policies. 30% reported that the family intake decreased to only one meal per day. (28)
• Many impoverished women are forced to adopt survival strategies, such as providing unprotected sexual intercourse in return for money, lodging, and food. (29,30)
• In Swaziland, the proportion of HIV-positive pregnant women attending antenatal clinics in 2000 ranged from 32.2% in urban areas to 34.5% in rural areas (5)
• In Botswana, the corresponding figures were 43.9% and 35.5% (5)

Notes for Editors

1. The review article, "Potential Impact of Adjustment Policies on Vulnerability of Women and Children to HIV/AIDS in Sub-Saharan Africa", was published in the June issue (published June 28th) of the Journal of Health, Population and Nutrition (JHPN)

2. The examples listed have a number next to them. These numbers correspond with the footnotes on the report which give source information for each citation. Please request a copy of the report (see contact details below).

3. Report authors: Roberto De Vogli, Department of Epidemiology, ¹û¶³Ó°Ôº and Gretchen L. Birbeck, African Studies Center and Departments of Neurology and Epidemiology, Michigan State University.

3. Media wishing to interview Dr De Vogli or want a copy of the report can contact Alex Brew at ¹û¶³Ó°Ôº's press office on 020 7679 9726 or a.brew@ucl.ac.uk For out-of-hours enquiries contact Alex Brew on 07747 565 056.