The economics of the global response to HIVAIDS

OUP CORRECTED PROOF – FINAL, 13/5/2016, SPi The Economics of the Global Response to HIV/AIDS OUP CORRECTED PROOF – FINAL, 13/5/2016, SPi OUP CORRECTED PROOF – FINAL, 13/5/2016, SPi The Economics of the Global Response to HIV/AIDS Markus Haacker OUP CORRECTED PROOF – FINAL, 13/5/2016, SPi Great Clarendon Street, Oxford, OX2 6DP, United Kingdom Oxford University Press is a department of the University of Oxford It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Markus Haacker 2016 The moral rights of the author have been asserted First Edition published in 2016 Impression: All rights reserved No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 2015956476 ISBN 978–0–19–871804–8 Printed in Great Britain by Clays Ltd, St Ives Plc Links to third party websites are provided by Oxford in good faith and for information only Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work OUP CORRECTED PROOF – FINAL, 13/5/2016, SPi Acknowledgements This book builds on work conducted from 2000, when the author was employed at the International Monetary Fund (through 2008), and since then includes consultancies with the World Bank and intermittently with UNAIDS from 2008, and stints visiting the London School of Hygiene and Tropical Medicine, the University of Oxford, and the Harvard T.H Chan School of Public Health Over the years, many individuals have contributed to the work this book builds on, by collaborating or providing their support, including (in alphabetical order) Arnab Acharya, George Alleyne, Abdoulaye Bio Tchané, Charles Birungi, Mark Blecher, Mariam Claeson, Paul Collier, Francis Cox, Stefan Dercon, Shantayanan Devarajan, Steven Forsythe, Nicole Fraser, Thembi Gama, Marelize Gorgens, Brigitte Granville, Robert Greener, Teresa Guthrie, Keith Hansen, Malayah Harper, Peter S Heller, Keith Jefferis, Erik Lamontagne, Elizabeth Lule, Khanya Mabuza, Faith Mamba, Ernest Massiah, Nokwazi Mathabela, Bill McGreevey, Gesine Meyer-Rath, Anne J Mills, the late Philip Musgrove, Regina Ombam, Mead Over, David E Sahn, Iris Semini, Pierre Somse, John Stover, Nertila Tavanxhi, Jacques van der Gaag, Alan Whiteside, David Wilson, Derek von Wissell, and Jonathan Wolff During the writing of the book, the work has greatly benefitted from the hospitality and academic resources of the Harvard T.H Chan School of Public Health and the support from Rifat Atun Michael Obst provided excellent research support through all stages of the work The work on the book did not receive any financial support Aspects of the book build on work undertaken under contract to the World Bank (especially the interpretation of policy commitments under the HIV/AIDS response as fiscal liabilities and the work on the cost-effectiveness of medical male circumcision) and UNAIDS (examples drawing on the analysis for the Kenya HIV/AIDS investment case, some of the content on domestic financing of HIV/AIDS responses) SarahJane Anderson, Geoffrey Barrow, Sergio Bautista, Íde Cremin, Katharine Kripke, Gesine Meyer-Rath, and Stephen Resch provided access to some of their data and ongoing work Yogan Pillay gave permission to utilize data from South Africa used in the discussion of HIV/AIDS policy design in Chapter 10 Nelson Musoba granted permission to reprint material from the Uganda HIV OUP CORRECTED PROOF – FINAL, 13/5/2016, SPi Acknowledgements investment case Theo Vos advised on the availability of Global Burden of Disease data I would like to thank my wife Veronika, who took much of the strain from writing this book, for her patience and support I regret that I could not spend more time with my two young sons, Otto and Ivan, over the year the book was written, and hope that one day you will take pride in this book vi OUP CORRECTED PROOF – FINAL, 13/5/2016, SPi Contents List of Figures List of Tables Introduction Defining Economic Focus Structure of the Book ix xi Part I The Global Impact of HIV/AIDS Health Impacts of HIV/AIDS The State of the Epidemic Placing the Impact of HIV/AIDS in Context Health and Demographic Consequences Some Notes on the Impact of the Global Response Impact on Individuals and Households The Socioeconomic Gradient of HIV/AIDS 9 13 19 29 30 31 The Economic Consequences of HIV/AIDS for Households and Individuals Orphans HIV/AIDS, Poverty, and Inequality Macroeconomic Consequences of HIV/AIDS Overview of Macroeconomic Consequences Modelling the Impact of HIV/AIDS on Economic Growth Empirical Evidence on the Impact on Economic Growth Economic Evaluation of the Health Consequences of HIV/AIDS 37 43 46 49 50 51 55 58 Part II The Global Response to HIV/AIDS History and State of the Global Response to HIV/AIDS The Course of the Global Response The Financing of the Global Response to HIV/AIDS Outlook on Financing and Sustainability 65 65 72 76 OUP CORRECTED PROOF – FINAL, 13/5/2016, SPi Contents Impact of the Global Response to HIV/AIDS Challenges of Attribution Achievements of the Global Response to HIV/AIDS Implications for Global Health Outcomes Has the Global HIV/AIDS Response Received too Much Money? 84 84 87 92 95 Part III Design and Financing of HIV/AIDS Policies Current Policy Challenges and Economic Perspectives Current Issues in HIV/AIDS Programme Design Understanding Cost-effectiveness Treatment Access, Survival, and the Calculus of Cost-effectiveness Cost-effectiveness of HIV/AIDS Programmes 103 104 106 109 Contribution to National Development Objectives 115 116 119 128 Cost-effectiveness of HIV/AIDS Interventions 134 ‘Returns to Investments’ in the HIV/AIDS Response Fiscal Space Analysis Population Heterogeneity and Effectiveness of HIV Prevention Interventions Condoms Prevention Measures Targeting Key Populations Medical Male Circumcision Treatment Conclusions and Outlook 10 Optimal HIV/AIDS Spending Allocations Combination HIV Prevention Assessing the Optimality of the HIV/AIDS Response ‘Bottom-up’ Determining Optimal HIV/AIDS Strategies 11 Sustainable Domestic Financing A Fiscal Perspective on Domestic HIV/AIDS Financing Fiscal Sustainability and the Costs of the HIV/AIDS Programme Efficiency and HIV/AIDS Programme Design Sources of Domestic Funding 134 141 146 155 161 174 175 176 178 192 200 201 204 209 213 12 Concluding Notes 220 Endnotes 223 255 283 References Index viii OUP CORRECTED PROOF – FINAL, 13/5/2016, SPi List of Figures 2.1 The global course of HIV/AIDS 10 2.2 Treatment access and AIDS-related mortality 11 2.3 AIDS, malaria, and TB deaths, and economic development 18 2.4 HIV incidence and prevalence, three countries, 1980–2014 20 2.5 Accumulated HIV infection risk, three countries, 1995–2020 23 2.6 Age profile of mortality, three countries, 2000 and 2014 25 2.7 Age profile of people living with HIV, Botswana, 2000 and 2014 26 2.8 Life expectancy at birth, three countries, 1980–2014 28 3.1 HIV prevalence, GDP per capita, poverty, and inequality 32 3.2 HIV/AIDS, ART, and workers’ productivity 39 3.3 Orphan rates and HIV prevalence, 2013 44 3.4 HIV prevalence and changes in poverty and inequality 47 4.1 Drop in life expectancy and equivalent income loss, applying ‘value of statistical life’, 2014 61 5.1 AIDS-related mortality among PLWH ever classified as Stage (AIDS), United States, 1987–2010 68 5.2 Resources available for HIV in low- and middle-income countries, 2000–2014 72 5.3 HIV/AIDS spending, HIV prevalence, and GDP per capita 74 5.4 HIV/AIDS spending, external financing, and domestic financing needs 76 6.1 HIV prevalence among young people, 2000 and 2014 88 6.2 Treatment coverage, HIV prevalence, and GDP per capita, 2013 90 6.3 AIDS-related mortality across countries, with and without treatment, 2014 91 6.4 Impact of HIV/AIDS and of treatment access on life expectancy at birth across countries, 2014 94 7.1 Framework for assessing the cost-effectiveness of HIV/AIDS policies and interventions 108 7.2 Health and financial consequences of new HIV infections with different treatment eligibility 110 OUP CORRECTED PROOF – FINAL, 17/5/2016, SPi References 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see also death AIDS Impact Model (AIM) 116, 234, 237; see also Spectrum (software package) ‘AIDS transition’ 24, 26, 224; see also ‘graying of AIDS’, age structure of people living with HIV amortization period 145, 160 anal intercourse 223 Angola 18, 32 antenatal care 96 antiretroviral drugs (AVRs) 51, 67–8, 109, 215, 251 antiretroviral treatment (ART) 1, 2, 4–5, 9, 11–12, 18–21, 30, 37–42, 55, 65, 67–8, 70, 84, 86–7, 90–6, 98–9, 104, 106–7, 110, 112–14, 119, 123–6, 130–3, 148, 158, 161–174, 176–80, 183–7, 190–1, 193, 195–6, 198, 205–7, 209, 212, 217, 221, 223, 225, 227, 230, 233–49; see also treatment as prevention combination therapy 67–8 costs of 80, 86, 99, 105, 107, 109–15, 132–3, 145, 156–8, 161–4, 170–3, 177, 180, 187–8, 193, 206, 215–17, 233, 238, 241, 243–4, 248–9, 251 costs of ART to patients/households 40–1 coverage (rate) 4–5, 28, 40, 65, 84, 89–90, 95, 108–9, 112, 114, 116, 119–20, 123, 126–7, 146, 157, 162, 164, 167, 170, 172–4, 176, 180, 183, 186–8, 197, 235–6, 245, 248–9 eligibility to 5, 40, 89, 108–11, 113–15, 117, 119–21, 123, 126–7, 129–30, 162, 164, 167–72, 174, 180, 183, 186–9, 205, 227, 237–8, 240, 246–9; see also CD4 count scaling-up of 4–5, 19–21, 24, 26–9, 40, 47, 51, 68–70, 89, 93–5, 99, 101, 103–4, 106, 109, 119–20, 123, 126, 128–9, 133, 161, 165, 167–8, 170, 172–3, 176, 178, 187, 192, 215–16, 220, 248 appreciation (of a currency) 51 ART; see antiretroviral treatment Asia 31 Asia and the Pacific 12 ASSA2008 model 135–7, 139–40, 143, 145, 160, 240, 245, 252 attribution (challenges of ) 4, 29, 84–7, 234 Avahan initiative 85–6, 151 Bahamas, The 18 balance of payments 54 Bangkok 245 behaviour change 10, 54, 69, 86–7, 104, 151, 154, 177, 195–6, 223, 246 borrowing 205, 213, 216–19, 238, 252 Botswana 12–13, 15, 19–20, 22–8, 32–4, 46, 57, 60–1, 73–6, 87–9, 91–2, 94–5, 166–7, 220, 224–6, 229, 243–4 Brazil 244 burden of disease 3, 14, 16–17, 19, 43, 63, 72, 79, 81, 98, 204–5, 224 Burkina Faso 18, 35 Burundi 78, 82, 243 Bush, George W 69 Cambodia 14–15, 41 Cameroon 18, 35, 92 Canada 107 Cape Town 246 capital-labour ratio 52–3 OUP CORRECTED PROOF – FINAL, 17/5/2016, SPi Index capital stock 52–3 Caribbean 12 cash transfer 35, 226, 244 CD4 count 28, 40, 89, 107, 109–14, 121–3, 133, 162–4, 167–72, 174, 180, 183–90, 197, 227, 235, 237, 240–1, 243–8 Central Africa 146; see also Africa Central African Republic 15, 32, 87–8, 243 child-headed household 45 child mortality 22, 24, 69, 108, 128 China 18 civil society 66, 97, 192, 232 clients of (female) sex workers 142, 148–52, 242 climate change 13 cohort 21–2, 25–7, 44, 110–11, 132–3, 158–9, 224, 233, 237 combination prevention 105, 147, 175–8, 236, 241, 247 communicable diseases 16–17 Comoros 94, 225 computable general equilibrium (CGE) model 54, 229 competitiveness 51 concentrated (HIV) epidemic 148, 176, 198, 234 condom (use/distribution) 5, 10, 85–7, 104, 134, 141–6, 148, 154, 156, 165, 176–7, 179–80, 183–6, 190, 219, 222, 236, 240, 244 Congo, Democratic Republic of the 60, 91, 228 Congo, Republic of the 15 consumption 50, 52, 96, 231, 239 Copenhagen Consensus (2004, 2008) 70, 232 cost-effectiveness 29, 66, 70–1, 101, 103, 106–14, 158, 212, 221, 229, 232, 236, 239, 245, 251, 253 of antiretroviral therapy 80, 98, 134, 161–74, 178, 188, 229 of condom use/distribution 141–6, 222 of global response to HIV/AIDS 84, 98–9, 117 of HIV/AIDS strategies/programmes/ policies 3–4, 50, 80, 101, 103, 105–8, 112, 114–34, 179–81, 194, 196, 199–200, 202, 204, 212, 221, 237, 240, 247, 250 of HIV (prevention) interventions 3–5, 50, 80–1, 98, 101, 103, 106–9, 111–14, 120, 127, 129, 134–75, 182–95, 197, 200, 203, 205, 208–10, 212, 221–2, 230, 237, 250–1 of medical male circumcision 155–61, 174, 222, 246 across age groups 158–61, 248 of prevention measures targeting key populations 146–55, 183 of scaling-up ART 129 of treatment as prevention 164–74, 245 284 costs caused by new HIV infections 126–7, 194, 217, 222, 242, 247 of HIV programmes 4–5, 107–8, 115, 170, 182, 187, 200–1, 204–9, 222, 238 per death averted 107, 111, 113, 116–18, 123, 174, 181, 184–6 per HIV infection averted (of one HIV infection) 4, 109–18, 121–3, 126–7, 152, 155–59, 161–2, 170–4, 179, 181, 183–9, 238, 240–3, 246, 248 per life year saved/gained 162–3, 170–2 Côte d’Ivoire 15, 18, 40, 48, 87, 223 CPIA index 251 critical enablers 122, 177, 191, 238 cross-sectional studies 37–8, 44 cut-off problem 122, 159, 170, 209, 243 Czech Republic 78 death 30, 38, 41–6, 59, 98, 131, 227–8, 238–9; see also AIDS(-related) deaths deaths averted 4, 29, 103, 106, 112, 116–18, 174, 180–1, 183–6, 192–3, 198, 248; see also costs – per deaths averted debt sustainability analysis (DSA) 206–7, 250–1 ‘Declaration of Commitment’ by the United Nations General Assembly Special Session on HIV/AIDS (2001) 13 Demographic and Health Survey (DHS) 34–7, 44–5, 96, 228 developing countries (less developed countries) 1, 9, 12, 29, 31, 44, 53, 58, 60, 66–8, 87, 89, 107, 131, 162, 165, 215, 224, 229, 232, 235; see also low- and middle-income countries development aid/assistance 1, 3, 51, 63, 69, 75, 80–1, 86, 93, 97–9, 202, 207, 214, 224, 236 DHS; see Demographic and Health Survey disability 50, 130, 172 discount rate (discounting, discounted) 111–13, 119, 121–2, 126, 144–5, 158, 161–3, 167, 170–1, 179, 181, 183, 188–90, 208–9, 237, 241–44, 246, 249 disease progression 1, 70, 104, 106, 109, 194, 198, 218, 221, 250 domestic financing/funding 3, 6, 72–3, 75–9, 81–3, 200–19, 233–4, 251–2 Domestic Investment Priority Index (DIPI) 78, 98, 233 donor 2, 71, 77, 82, 96, 104–5, 165, 178, 192, 200, 204, 206, 212, 215, 233, 249–50, 252 downstream infections 3, 106, 138–40, 150, 153–5, 160, 168–9, 221, 236, 240, 245–6 Doyle model 252 OUP CORRECTED PROOF – FINAL, 17/5/2016, SPi Index DSA; see debt sustainability analysis dual economy model 53 Dutch disease 51 early infant male circumcision 159, 161 East(ern) Africa 43, 146, 158, 230; see also Africa Eastern Europe and Central Asia 12–13, 246 Ebola 81, 204, 218, 234, 253 economic growth 7, 49, 51, 58–9, 79–80, 108, 129, 213, 224, 230, 238, 250, 252; see also HIV/AIDS – impact on economic growth economies of scale 191,193, 210 economies of scope 211 Ecuador 244 education 22, 31, 34–7, 45–6, 50, 52–55, 130, 226–7, 229 as means of HIV prevention 34–6 effectiveness of alternative HIV policies 116, 204, 222 of global response to HIV/AIDS 84, 99, 104 of HIV (prevention) interventions 5, 49, 85, 105, 108, 134–41, 150, 175, 178, 182–9, 192, 194, 198, 212, 221, 237, 248 across age/population groups 5, 105, 142–4, 175 across locations 105 of condom use 141–6 of male circumcision 85, 158, 178–9, 232, 234, 243, 246 of pre-exposure prophylaxis 166, 173 of treatment as prevention 165, 167, 172, 178–9, 232 of national response to HIV/AIDS 128–9, 191 of spending allocations 179 in averting HIV infections or deaths 117, 142, 187 efficiency 71, 76, 191, 194, 196, 200–4, 209–13, 221, 226, 232, 247 of HIV prevention interventions 194 of HIV program allocations 3, 190 emerging markets 207 employment 39, 45, 47, 51, 239 ‘ending AIDS’ 2, 63, 65, 71, 77, 106, 164, 167, 178, 202, 219, 223, 236, 244, 247 ‘entitlement burden’ 69, 206 Equatorial Guinea 18, 87–8, 224 essential government functions 201–4 Ethiopia 21, 91, 223, 243 European Plague external financing/funding 4, 51, 71–3, 75–7, 79, 82–3, 99, 204, 207, 213, 215–16, 232–4, 250–2; see also development aid/ assistance female sex worker 85, 142, 146, 148, 150–5, 183–6, 190, 196–7, 242, 245; see also sex worker financial liability 82, 114, 193, 205–9, 222, 238 financial sustainability 233 of global HIV response 2, 4, 63, 65, 76–83 of national HIV response / HIV programmes 3, 6, 71, 77, 80, 103–4, 112, 127, 146–7, 161, 168, 182, 199–219, 222 of public debt 82, 205–7, 251 of scaling up of HIV treatment 70, 165 financing gap; see funding gap fiscal space 112–13, 115, 119–28, 142, 146–7, 199–201, 205–6, 210, 217, 219, 222, 237, 250–1 fiscal quasi-liability; see financial liability formal sector 41, 53 funding gap 79, 213 funeral costs 42, 130–1, 239 funeral policy 42 Gabon 18, 32, 88 Gambella 243 Gates Foundation 210 GDP (gross domestic product) 18, 31, 49–56, 71, 73–6, 79–80, 82, 99, 108, 123, 128–31, 204, 207–8, 213, 218, 220–1, 229, 234, 238–9, 250–2 GDP per capita 4, 7, 16, 18–19, 31–4, 46, 48, 50–61, 73–6, 80, 82–3, 89–91, 126, 128–30, 181, 208, 213, 220, 224–5, 228, 231, 233–5, 239 generalized (HIV) epidemic 135, 140, 148, 167, 176, 198, 234, 242, 247 Ghana 35, 48 Gini index 32–3, 46–7, 225, 228 global financial crisis 2, 70–1 Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) 1, 65, 69, 71–2, 78, 83, 96–7, 104–5, 132, 178, 233, 235–6 Global Programme on AIDS (GPA) 66, 232 global response to HIV/AIDS 1–2, 4, 7, 13, 15, 29, 63–99, 162, 176–7 cost of 99 course of 4, 63–83 financial commitments 1, 71, 82 financing of 2–4, 63, 65, 70–83 impact of 4, 29, 63, 84–99, 162, 200, 220, 235, 243 policy discourse 1, 4, 30, 63, 65–72, 76–7, 98, 103, 116, 128, 133, 147, 164, 176, 198, 201–2, 214 transition from emergency response 14–15, 70, 76, 212 GNI (gross national income) 78, 80, 224 GNI per capita 212–13 285 OUP CORRECTED PROOF – FINAL, 17/5/2016, SPi Index GNP (gross national product) 31 ‘Goals’ model 86, 116, 194, 234, 237, 248–9; see also Spectrum (software package) government expenditures 50, 81, 201–3, 206–7, 213, 215, 218, 251 government revenues 49, 50, 73, 75, 78–80, 99, 108–9, 131, 201–3, 206–7, 213–14, 218, 239, 250–2 grant 82, 96–7, 201–2, 215–16, 239 ‘graying’ of HIV/AIDS 3–4, 24, 224; see also ‘AIDS transition’, age structure of people living with HIV Greece 251 gross domestic product; see GDP gross national income; see GNI gross national product; see GNP Guinea 218 Guinea-Bissau 18, 228 Haiti 44, 73–4, 76, 82, 86, 223 Harvard Consensus Statement (2001) 68 health insurance 41, 213, 216–17 health personnel 95, 97, 166 health production function 195–6 health sector 66, 80, 95–7, 214 health shock 1, 2, 9, 14, 19, 49, 52, 59, 81, 89, 95, 204, 218, 220 health spending 55, 79–81, 120, 204, 233 health system 2, 68, 92, 96–7, 104 heterosexual transmission of HIV 21, 34, 66; see also HIV transmission dynamics high-income countries 16–18, 65, 67, 224, 243 HIV/AIDS 9, 65, 69 as a chronic disease 1, 4, 24, 38, 98, 109, 112 development impact 2, 9, 14–15, 30–1, 49, 51, 58, 66, 68, 87, 104, 108, 115, 200 demographic impact 19–28, 50, 52–4, 216, 220–1 distribution across countries 3, 15–16, 31, 44, 94–5 economic impact 2, 7, 9, 14, 19, 23, 29–30, 38, 49, 55, 58, 63, 66, 70, 104, 108, 115, 128, 132–3, 178, 192, 220, 224, 230, 232; see also HIV/AIDS – impact on economic growth, HIV/AIDS – macroeconomic impact health impact 2, 3, 7–29, 38, 58, 61, 63, 67, 84, 87, 92–7, 99, 103–4, 106–13, 122, 128, 133, 164, 170, 174, 177–8, 182, 192, 200, 209, 220–1, 223, 230, 243 impact on economic growth 4, 21–2, 48–9, 51–7, 220–1, 228; see also HIV/AIDS – economic impact, HIV/AIDS – macroeconomic impact impact on government employees 50, 108–9 impact on households 4, 7, 30, 37–48, 50–1, 53–5, 58, 66, 128, 220, 227–8, 238–9 286 impact on individuals 4, 30, 37–48, 51, 128, 220, 227, 238 impact on poverty 4, 30–4, 37, 42, 46–8 impact on private sector 51 impact on women 34 macroeconomic impact 4, 7, 9, 46, 48–61, 229; see also HIV/AIDS – impact on economic growth, HIV/AIDS – economic impact social impact 2, 7, 14, 19, 23, 29, 63, 66, 70, 192, 227, 232 state of HIV/AIDS epidemic 3, 9–13, 67, 116, 122, 128, 147, 193–4, 196–7, 223, 232, 247 HIV/TB-co-infection 180 HIV epidemic; see concentrated (HIV) epidemic, generalized (HIV) epidemic, hyperepidemic (HIV) epidemic HIV incidence 2, 4–5, 10–11, 19–22, 24, 26–7, 29–30, 37–8, 70–1, 84–7, 89, 104–8, 112, 114–15, 119–20, 123, 126, 134–6, 139, 141–3, 147–51, 154, 156–60, 164–8, 172–4, 176, 178–81, 187–9, 194–7, 203, 209, 216–18, 223–7, 232, 234–5, 241–4, 247–9 financial savings from reduced HIV incidence 4, 70, 104–5, 107, 115–20, 122, 126–7, 142, 157, 164, 167–8, 170, 177, 180–2, 186–92, 238 HIV prevalence 4, 10, 12, 16, 18–22, 24, 27–8, 30–7, 41, 44, 46–9, 54, 56–8, 70, 73–5, 78, 82–7, 89–90, 92–3, 96, 98–9, 108, 135–7, 142, 144, 146–9, 155–6, 161, 172–3, 196–7, 204, 208, 211–13, 220, 223–6, 228, 230–2, 234–6, 240–1, 243–4 across locations 36, 196, 225–6 among young people 4, 87–8 and education 35–7 female-to-male ratio 34–5 for women 36, 87–9, 135–7 for men 87–9, 135–7 HIV prevention 4, 11, 29–31, 35–6, 66–7, 69–70, 73, 86, 89, 99, 101, 104–9, 112–13, 115–16, 119, 123, 126–7, 129, 134–6, 141–2, 145, 148, 150–1, 155, 158, 164, 168, 175–6, 209, 214, 237, 240–1, 247–9 HIV testing and counselling (HTC); see voluntary counselling and testing (VCT) HIV transmission (dynamics) 2–3, 5, 66, 69–71, 86, 101, 104–6, 123, 135, 138–51, 154, 156, 160, 164, 166, 168–70, 172, 174–6, 178, 193, 196–8, 216, 221, 226, 234, 240–2, 245, 247 HIV treatment, see antiretroviral treatment (ART) Homa Bay 12 OUP CORRECTED PROOF – FINAL, 17/5/2016, SPi Index household expenditures 37, 40 HPTN 052 trial 166, 244 human capital 52–3, 55, 228 hyperepidemic (HIV) epidemic 176, 247 immunity 11 immunization 93, 96, 213 income 34, 36, 38, 40–2, 46, 48, 55, 58–61, 82, 216, 225, 227, 229–31, 239 lifetime income 58–9 income tax 131 India 18, 85–6, 92, 142, 151, 172, 227, 231, 240 Indonesia 18, 91–2 inequality 2, 30–3, 36, 46–8, 58–9, 92, 225, 228–9 infant mortality 22, 56, 230 infections averted 106, 115–18, 134, 138–45, 151, 153, 156–60, 164, 169–70, 178, 180–8, 190, 192–6, 221–2, 236–8, 240–1, 246, 248–9; see also costs – per HIV infection averted infectious disease 97 inflation 54, 237 influenza 11 influenza of 1918 informal sector 53 injecting drug users/use 33, 66, 105, 146, 148–9, 151, 166, 184–6, 190, 241, 245–6, 248 International Federation of Red Cross and Red Crescant Societies 13 International Monetary Fund (IMF) 206, 232 investment 50–1, 53–4, 56, 59, 229; see also returns to investment investment case 103, 105, 108, 131, 179, 234 Kenya 79, 123, 234 South Africa 183, 197, 248–9 Uganda 168, 179–82 investment framework Kenya 123–9, 238 UNAIDS investment framework 1, 4, 65, 71, 86, 103–5, 107, 115–20, 147, 155, 164–5, 177–8, 191–2, 221, 236, 247 investment rate 52 Iran (Islamic Republic of ) 15 Iraq 230 Jamaica 12, 19–25, 27–8, 60–1, 148, 150, 152–3, 155, 208, 224, 241 Japan 251 Joint United Nations Programme on HIV/AIDS (UNAIDS) 1, 13, 24, 65, 67, 69, 71, 73, 78–9, 84, 94, 98, 104–6, 116, 131, 133, 169, 172, 225, 233, 252 Kagera 43 Kazakhstan 14–15 Kenya 12–13, 15, 19–25, 27–8, 32, 34–5, 38–9, 41–2, 48, 56, 60–1, 79–80, 86, 91, 93, 123–7, 129, 156, 166–7, 195–6, 207–8, 211, 213–15, 217, 223–4, 227, 234, 241–3, 245, 247, 249, 252 key populations 5, 104–5, 116, 123, 146–55, 166, 175, 177, 180, 214, 241, 247 know your epidemic, know your response 176–7, 226 KwaZulu-Natal 12–13, 35–6, 42, 173, 179, 182, 194, 226–7, 229, 236, 248 labour productivity 52–3 labour supply 52–4 laboratory 93, 96–7 Lake Victoria 21 Latin America 12–13 Lesotho 15, 18, 32–3, 35, 74–6, 88, 91, 94–5, 226, 235, 243 Liberia 82, 218, 243 life expectancy (at birth) 1, 7, 9, 14, 19, 27–9, 48, 50, 53–61, 84, 94–6, 107–8, 128–9, 162, 192, 220, 223, 230–1, 235–6, 239, 247 recovery owing to HIV treatment 3, 27–9, 56, 94–5, 99, 128–9, 162 remaining life expectancy 160, 243, 246 after HIV infection 61, 107, 111–12, 162–3, 171, 246 life years lost/saved/gained 4, 29, 98, 106, 133, 162–4, 169–71, 192, 195, 198, 239, 246 living standard 9, 14, 48, 50, 58–61, 129, 133, 231 longitudinal studies 37–8, 43–4 low-income countries 16–19, 34, 60, 67–8, 73, 75, 82–3, 90, 99, 207, 224, 226, 231, 235, 239, 243, 251; see also low- and middleincome countries low-level (HIV) epidemic 176 low- and middle-income countries 1, 12, 16, 29, 69, 72, 98, 146, 176, 210, 212, 224, 235–6, 251; see also low-income countries, middle-income countries lower-middle-income countries 17–18, 235; see also middle-income countries Madagascar 13, 78 malaria 2–3, 14, 16–19, 69, 96–7, 224 Malawi 32, 35–6, 40, 42, 45, 87–8, 91, 93–5, 223–4, 226, 228, 243 male circumcision 35 , 57, 69–70, 148, 155, 176, 178–9, 230, 242; see also medical male circumcision Mali 18 Manicaland 37 maternal health 69 Mauritius 32, 225 287 OUP CORRECTED PROOF – FINAL, 17/5/2016, SPi Index medical injection 149 medical male circumcision 2–3, 5, 11, 85, 89, 104, 109, 114, 134, 155–61, 168, 172, 174–5, 177, 179–80, 183–6, 190, 194–7, 218, 222, 232, 234, 236, 238, 241–4, 246, 248; see also male circumcision effect by age of circumcision 5, 159–61, 243 men who have sex with men (MSM) 10, 21, 33, 105, 141, 146, 148–55, 166, 195–6, 223–4, 244 Middle East and North Africa 12–13 middle-income countries 16, 73–5, 83, 90, 239; see also upper-middle-income countries, lower-middle-income countries migrants 33 Millennium Development Goals (MDGs) 69, 80, 236 mining 54 modes of transmission framework 5, 147–54, 177, 198, 241, 247 morbidity 9, 29, 51–2, 71, 104 mortality 16–18, 21–7, 31, 41, 50, 52, 54–5, 58–61, 84, 91–3, 96, 129, 224–5, 227, 231, 237; see also HIV/AIDS – impact on mortality, AIDS-(related) deaths, child mortality, infant mortality, neonatal mortality among people living with HIV 1, 7, 9, 11–12, 24–5, 27, 29, 37, 48, 84, 89, 90, 92–3, 111–12, 194, 223 AIDS-related mortality 10–13, 21, 25, 51, 57, 60, 65, 67, 71, 89–91, 98–9, 104, 114, 180, 186, 221, 226–8, 234–5 concentrated among (young) adults 31, 42–3, 55, 57 most-at-risk populations; see key populations mother-to-child transmission 26, 160, 165; see also prevention of mother-to-child transmission Mozambique 12, 18, 32, 42, 82, 91–2, 94–5, 224, 243 MSM; see men who have sex with men Nairobi 36 Namibia 15, 18, 32–3, 73–6, 87–8, 90–1, 94–5, 243 National AIDS Spending Assessment (NASA) 233 neglected tropical diseases 16–17 neoclassical growth model 51 neonatal mortality 93, 96 nevirapine 166, 244 new funding model (Global Fund) 83, 105, 236 new growth theory 52–4, 229 New York Times 230 Niger 12 Nigeria 12, 18, 32, 40, 91, 94–5 288 North America 210 North Korea (Democratic People’s Republic of Korea) 14–15 nutritional status 39, 41, 45 nuclear weaponry 13 nutrition 97 Nyanza 243 oil revenues 18 opportunistic infections 38 Optima model/software 198, 250 optimal HIV spending allocations / HIV strategy 3, 5, 86, 101, 114–15, 127, 145, 154, 174–99, 205, 209, 221, 237–8, 247, 249 orphan 4, 23, 30, 38, 41, 43–5, 50, 54, 131–2, 228, 239, 247 orphans and vulnerable children (OVC) 44–5 ORPHEA project 210, 212, 233, 251 out-of-pocket expenditures 40, 227 out-of-sample projection 60 Over, Mead 80 Papua New Guinea 44 PEPFAR; see United States President’s Emergency Plan for AIDS Relief Peru 244 Piot, Peter 13, 71 PMTCT; see prevention of mother-to-child transmission population-level effect of HIV prevention interventions 134, 138, 140–4, 153, 156, 167, 221–2 post-exposure prophylaxis 166, 244 poverty 9, 31–4, 36, 42, 46–50, 58, 225–6, 228, 239, 246; see also HIV/AIDS – impact on poverty, poverty line, poverty rate poverty line 46, 48, 50, 60, 225 poverty rate 31–3, 46–8, 108, 128, 220–1, 228, 239 poverty trap 55 pre-exposure prophylaxis 166, 172–3, 195–6 present discounted value 120 prevention of mother-to-child transmission (PMTCT) 11, 22, 69, 93, 104, 116, 128, 165–6, 176–7, 179–80, 192, 212, 244, 246, 249; see also mother-to-child transmission private HIV spending 50 private sector 213 productivity 50–4, 56, 115, 130, 132, 227, 230, 247 loss because of HIV/AIDS 38–40, 133 recovery on ART 39, 107, 115, 130, 132–3, 239 profitability 51 OUP CORRECTED PROOF – FINAL, 17/5/2016, SPi Index prostitution 66 public debt 71, 205–7, 238, 250–1 public health spending 80 public HIV spending 50, 78 reproductive health care/services 93, 96–7, 244 retention 245 returns to investment 4–5, 49, 63, 66, 71, 77, 85, 103–5, 108–9, 112–13, 115–19, 127, 129, 131–3, 147, 160–1, 164, 174–5, 177, 183, 187, 189–92, 194, 200, 209, 212, 219, 221–2, 229, 232, 236–7, 239, 243, 248, 253 reverse causality risk behaviour 29, 150, 154, 193, 198, 226; see also sexual risk behaviour risk/probability of contracting/acquiring HIV/ AIDS 11, 21–3, 33–6, 54–5, 87, 106, 134–45, 147, 150–1, 153, 155–7, 166, 168, 173, 216, 219, 223–4, 226–7, 230, 234, 240, 242 risk/probability of passing on HIV/AIDS 5, 11, 135, 137–8, 141, 147, 150–1, 164–5, 168, 178, 240–2 Russian Federation (Russia) 14–15 Rwanda 14–15, 42, 73–4, 76, 82, 211, 223, 243 salary 51, 74, 80, 210, 252 San Francisco 147 sanitation 31 savings 52–3 school attendance 39, 41, 45, 56; see also education Senegal 34 sero-discordant couples 141–2, 144–5, 153, 165–6, 168, 172, 180, 247 sexually transmitted disease 22, 66, 147, 223, 240–2, 249 sexual risk behaviour 5, 10, 66, 86–7, 134–6, 142, 147–54, 160, 165, 175, 179, 180, 222, 240; see also risk behaviour sexual transmission of HIV 22, 146, 160, 165, 176, 245; see also HIV transmission (dynamics) sex worker 10, 33, 105, 141, 146, 149, 195, 240, 249; see also female sex worker Seychelles 225 Sidibé, Michel 71 Sierra Leone 15, 94, 218, 235 social determinants of HIV/AIDS 4, 30–1, 34, 36–7, 226, 232; see also socioeconomic gradient of HIV/AIDS socioeconomic gradient of HIV/AIDS 30–1, 34, 38, 53; see also social determinants of HIV/AIDS social mitigation of HIV/AIDS 108, 122 Somalia 21, 94 South Africa 12–13, 15, 18, 32–3, 41, 45, 51, 54–5, 74, 76, 86, 88, 90–5, 107, 130, 135–3, 145, 158, 160–1, 166–9, 172–4, 183, 197, 210–11, 220, 223, 227, 229, 235, 237–8, 240, 242–50, 252 South East Asia 195 Southern Africa 146, 158, 230, 243; see also Africa Spectrum (software package) 22, 116, 135, 169, 224–5, 234–5, 237, 245, 248 spending commitments (financial commitments) 5, 101, 103, 108, 112, 119–23, 126–7, 168, 183, 188, 189, 193, 199, 204–9, 218, 222, 238, 249, 251 Stover, John 80 sub-Saharan Africa 10, 12–13, 15–17, 21, 30–4, 36, 43–5, 51, 54, 56, 58, 67, 79, 80, 128, 146, 155, 167, 195, 223–5, 228, 232, 245–6; see also Africa ’sugar daddy’ 33, 35; see also age-disparate sex survival 107, 109–10, 123–4, 133, 156, 168, 186, 193 improvement due to HIV treatment 24, 26, 28–9, 37, 68, 92–4, 107, 110–12, 130–4, 162, 188, 221, 235, 239, 248 Sustainable Development Goals (2015) 66, 72 Swaziland 12–13, 15, 18, 32–5, 48, 55, 73–6, 88–9, 91, 94–5, 167, 208–9, 226, 243, 245 Swift, Jonathan 60, 231 Switzerland 89 Syrian Arab Republic 15 Tanzania 32, 34–5, 43, 45, 76, 91–3, 215, 243 tariffs 131 tax policy 201–3, 213–16, 252 tax revenues 130–1, 218, 239 tea plucker 38–9 Thailand 91, 244 THEMBISA model 197 time horizon/frame/period 3, 5, 37, 42–3, 71, 104, 112, 114–15, 117, 119, 122, 128, 134, 147, 150–1, 157, 159–61, 168, 172, 175, 177, 181–2, 186–7, 189–94, 198, 208–9, 224, 228, 231, 246–8 Timor-Leste 15 training 95–6 transactional sex 33, 35 transport 54 travel expenses 40–1 treatment, see antiretroviral treatment (ART) treatment as prevention 2–3, 69–70, 80, 85, 105, 109, 134, 164–76, 178–9, 232, 234–7, 245, 247 Trinidad and Tobago 18 trust fund 214–16, 252 tuberculosis (TB) 3, 16–19, 96–7 289 OUP CORRECTED PROOF – FINAL, 17/5/2016, SPi Index Uganda 15, 32, 43, 86, 88–9, 91, 93, 166, 168, 179–82, 194, 208–9, 214, 223, 242–3, 247, 252 UNAIDS; see Joint United Nations Programme on HIV/AIDS UNAIDS ‘Drug Access Initiative’ 68 UNAIDS investment framework; see investment framework unit costs 74–5, 80, 89–90, 99, 114, 126, 161, 183, 191–3, 198, 210–12, 237, 252 United Kingdom 71, 89 United Nations Political Declaration (2006) 30 United Nations Population Division 14, 223 United States 9, 24, 60, 67–8, 71, 86, 107, 206, 244 United States President’s Emergency Plan for AIDS Relief (PEPFAR) 65, 69–72, 93, 96, 105, 212, 232 universal health coverage 216 upper-middle-income countries 16–18, 83; see also middle-income countries urbanization 66 vaccine 156, 242–3 vaginal intercourse 34, 223 value added tax 131 290 value of statistical life 59–61, 230–1 Vancouver consensus 164 Venezuela 141 Vietnam 15, 141, 172 viral suppression 69, 167, 245 voluntary counselling and testing (VCT) 142, 165, 179–80, 184–6, 190–1, 197, 210–12, 249 wage 51, 60 Wajir 12 wealth 34, 36–7, 45, 226–7 Western Africa 146; see also Africa Western and Central Europe and North America 12–13 Western Cape 12–13 World Bank 51, 66, 80, 206, 216, 224, 235, 250–1, 253 World Health Organization (WHO) 12, 66, 68–9, 129, 162, 239 Zambia 15, 18, 32, 42, 48, 88–9, 91, 93–5, 172, 211, 224, 243 Zidovudine 244 Zimbabwe 15, 18, 32, 35, 37, 44, 86–8, 91, 93–5, 142, 148, 150, 152–3, 214–15, 223, 226, 240–3, 252 ... Consequences of HIV/AIDS 37 43 46 49 50 51 55 58 Part II The Global Response to HIV/AIDS History and State of the Global Response to HIV/AIDS The Course of the Global Response The Financing of the Global. .. addition to the severity of the impact of these diseases in the respective countries (the height of the respective bars), the figure also shows the distribution of the global burden from these three... CORRECTED PROOF – FINAL, 13/5/2016, SPi The Economics of the Global Response to HIV/AIDS Chapter 11 returns to the issue of financing the HIV/AIDS response, discussing the financing needs and the sustainability