A W O R L D B A N K P O L I C Y R E S E A R C H R E P O R T CONTEXTUAL DETERMINANTS OF HIV Findings from “Confronting AIDS” Mead Over Development Research Group, World Bank A W O R L D B A N K P O L I C Y R E S E A R C H R E P O R T

EUROPEAN C OMMISSION UNAIDS THE WORLD BANK

A W O R L D B A N K P O L I C Y R E S E A R C H R E P O R T Overview 4 Ho: Supply and demand for commercial sex acts drive the epidemic 4 Evidence for contextual determinants of urban Hiv prevalence 4 Policy recommendations

A W O R L D B A N K P O L I C Y R E S E A R C H R E P O R T Demand for commercial sex M/F ratio in urban centers (+) Military men (+) Migrants (+) Male income (+) Quality of commercial sex (+) Price of commercial sex (-) Quantity Price Demand

A W O R L D B A N K P O L I C Y R E S E A R C H R E P O R T Supply of commercial sex M/F education ratio (+) Female income (-) Female earnings opportunities (-) Cultural constraints (-) Safety of commercial sex (+) Price of commercial sex (+) Quantity Price Supply

A W O R L D B A N K P O L I C Y R E S E A R C H R E P O R T Ho: Supply and demand for commercial sex acts drive the epidemic Factors that shift either supply or demand to the right will exacerbate epidemic If cheap commercial sex is most risky, supply shifts to right are worse than demand shifts Quantity Price Demand Supply Po Qo

A W O R L D B A N K P O L I C Y R E S E A R C H R E P O R T Evidence for contextual determinants of urban HIV prevalence Data on HIV Prevalence: – Urban high and low prevalence rates c in 72 countries, from U.S. Bureau of Census database Data on socioeconomic determinants: –Standard World Bank sources Available on the web from STATA Technical Bulletin (search for -regmsng-)

A W O R L D B A N K P O L I C Y R E S E A R C H R E P O R T Regressions explaining the percentage of the urban population infected with HIV (1)

A W O R L D B A N K P O L I C Y R E S E A R C H R E P O R T Regressions explaining the percentage of the urban population infected with HIV (2)

A W O R L D B A N K P O L I C Y R E S E A R C H R E P O R T Regressions explaining the percentage of the urban population infected with HIV (2) Weakened

A W O R L D B A N K P O L I C Y R E S E A R C H R E P O R T GNP per Capita, Income Inequality and Urban Adult HIV Infection 72 Developing Countries Urban adult HIV prevalence GNP per capita (1994 US$) 1,1003,0008, Zambia Malawi Haiti 0 Honduras Guyana Spain Lao PDR Zimbabwe Thailand China b ARE Rep. of Korea Botswana Inequality of income distribution Spain India Rep. of Korea Pakistan China Lao PDR Haiti Zambia b ARE Thailand Guyana Honduras Botswana Zimbabwe 0 0 Malawi

A W O R L D B A N K P O L I C Y R E S E A R C H R E P O R T Conclusions from the regressions explaining urban HIV infection  Poverty and income inequality facilitate spread of AIDS F Gender inequality facilitates spread F High risk groups drive the epidemic –Soldiers –Sex workers

A W O R L D B A N K P O L I C Y R E S E A R C H R E P O R T Policy Recommendations 4 Targeting prevention to those with the highest risk behavior is an indispensable dimension of all intervention programs for preventing the impact –On low- as well as on high risk –On poor as well as on rich 4 Policies to alter market should focus on improving quality of commercial sex by raising the opportunity cost of women –female education –micro-credit targeted to women –jobs for women in urban areas

A W O R L D B A N K P O L I C Y R E S E A R C H R E P O R T Web Site of the International AIDS Economic Network