Economic Inequality and HIV/AIDS in Latin America and the Caribbean: A Nefarious Link Karl Theodore Health Economics Unit (HEU) The University of the West Indies 5th August, 2008.

The Issue The concern is whether and to what extent conditions of inequality drive or exacerbate the HIV/AIDS epidemic. Race and gender are usually vehicles of inequality – the inequality of power, opportunity and income. It is noteworthy that inequality and the social problems emanating from inequality pre-existed HIV/AIDS and are entrenched in society. In fact, the HIV/AIDS-inequality connection may be seen as a cycle with stigma and discrimination completing a nefarious loop .

Fig. 1: The HIV/AIDS-Inequality Cycle ORRRRRACER INEQUALITY STIGMA & DISCRIMINATION HIV/AIDS A NEFARIOUS LOOP

Income Inequalities in Latin America and the Rest of the World (Gini Coefficients) Source: Checchi (2000) What the table shows is that Latin American countries have some of the highest levels of income inequality in the world with an average Gini coefficient above 0.50 since the 1960s. Moreover, while in all regions of the world, inequality decreased between 1960 and 1995, it increased in Latin America.

Comment (1) It is not surprising that an epidemic as potentially destructive as HIV/AIDS will feed on the dysfunctionalities which exist, in this case, the propensity to inequality. Whether it is through gender, race or geographic location, an epidemic that feeds on social vulnerabilities would certainly use inequality as fuel to foster its deadly progress. An opportunity here?

Comment (2) What is now widely acknowledged is that the stigma and discrimination associated with HIV/AIDS would certainly create a platform for further inequality. In respect of opportunities available to citizens, the evidence suggests that PLHA now face extremely challenging times.

Comment (3) What the diagram (Fig. 1) suggests is a perpetuation of both HIV/AIDS and inequality making the inequality picture in LAC even worse if no conscious interventions are made to break the cycle that connects the two. Obvious areas of vulnerability: education, health, housing and employment.

Recommendation These areas of vulnerability must now become the focus of HIV/AIDS response programmes. The good news is that in focusing on these we would not be starting from ground zero. In nearly every country of the region there are programmes and measures aimed at addressing inequality in these areas. Research-based suggestions?

A three-tier system of policies against inequality (i) the establishment of progressive tax systems, (ii) The promotion of equal opportunities, and (iii) the reduction of discrimination in all areas of society. "Inequality in Latin America: Processes and Inputs" Partricia Justino and Arnab Acharya, Sussex, 2003

Areas of HARP Responsibility (1-2) In a nutshell there would seem to be at least four (4) responsibilities of the HIV/AIDS Response Programmes: (HARPs) 1. Collating adequate information on the inequality programmes and measures in place in different countries. 2. Monitoring the impact of these programmes and measures on HIV risk groups as well as on PLHA.

Areas of Responsibility (3-4) 3. Lobbying and/or advocating for adjustments in focus or intensity of inequality programmes and measures: using HIV/AIDS for upgrading public policy. 4. Establishing and sustaining links with international agencies engaged in monitoring inequality with a view to identifying points of entry for breaking the HIV/AIDS-inequality cycle. Agencies here include the UNDP International Poverty Centre, the WIDER Institute, the IDB Poverty and Inequality Research Unit and CEPAL.

The End Thank you for your attention. Any questions/ comments/ suggestions?