Document 1821
 DOCN  M94A1821
 TI    The impact of International Monetary Fund and World Bank policies on HIV
       transmission in developing countries.
 DT    9412
 AU    Lurie P; Lowe RA; Hintzen P; Center for AIDS Prevention Studies, U of
       California, San; Francisco.
 SO    Int Conf AIDS. 1994 Aug 7-12;10(1):443 (abstract no. PD0380). Unique
       Identifier : AIDSLINE ICA10/94370754
 AB    OBJECTIVE: To describe the impact of the International Monetary Fund and
       World Bank lending policy of structural adjustment (SA) on risk factors
       for HIV transmission in developing countries. SA programs are a complex
       of policies applied primarily to developing countries suffering balance
       of payments deficits and that seek to stimulate growth in the private
       sector and bolster the export sector. METHODS: We reviewed the
       epidemiology of HIV and its risk factors in developing countries as well
       as reports on economic development by the World Bank, UNICEF and others.
       RESULTS: SA programs require: 1. Reduced government spending on health
       and social services; 2. Personal income tax increases; 3. Export
       promotion; 4. Currency devaluation; 5. Concessions to foreign investors;
       and 6. Increases in the prices of goods and services. The following
       social phenomena appear to have been promoted by these policies: 1.
       Declining sustainability of rural subsistence economies as economic
       activity shifts to the export sector; 2. Increasing poverty and
       landlessness, particularly in rural areas, as social services are scaled
       back and prices increase; 3. Development of of a transportation
       infrastructure to serve the export economy; and 4. Increasing
       urbanization. These factors have contributed to the disruption of family
       life as rural-dwellers have left rural areas for the city in search of
       employment; HIV seroprevalence has become substantial along
       transportation routes in many countries. A drug trade has grown up in
       many urban centers. Migrant workers from the countryside and in some
       cases tourists lured by favorable foreign exchange rates frequent
       commercial sex workers, potentially spreading HIV infection. Migrant
       workers may introduce HIV into rural areas when they return to visit
       family members. Efforts to promote behavioral change or treat HIV
       disease are stymied by declining expenditures on health and social
       services. DISCUSSION AND CONCLUSIONS: SA programs appear to have
       contributed to fundamental changes in the social and economic structures
       of many developing countries. These changes may have promoted the
       dissemination of HIV in some developing countries.
 DE    Developing Countries/*ECONOMICS  Human  HIV
       Infections/EPIDEMIOLOGY/*TRANSMISSION  *International Agencies  Risk
       Factors  Socioeconomic Factors  United Nations  MEETING ABSTRACT

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