CONTEXTUAL DETERMINANTS OF HIV Findings from

1
CONTEXTUAL DETERMINANTS OF HIV Findings from
Confronting AIDS
Mead Over
Development Research Group, World Bank
2
THE WORLD BANK
EUROPEAN COMMISSION
UNAIDS
3
Overview

• Ho Supply and demand for commercial sex acts
  drive the epidemic
• Evidence for contextual determinants of urban Hiv
  prevalence
• Policy recommendations

4
Demand for commercial sex

• M/F ratio in urban centers ()
• Military men ()
• Migrants ()
• Male income ()
• Quality of commercial sex ()
• Price of commercial sex (-)

5
Supply of commercial sex

• M/F education ratio ()
• Female income (-)
• Female earnings opportunities (-)
• Cultural constraints (-)
• Safety of commercial sex ()
• Price of commercial sex ()

Price
Quantity
6
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

Supply
Po
Qo
7
Evidence for contextual determinants of urban HIV
prevalence

• Data on HIV Prevalence
• Urban high and low prevalence rates c. 1995 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-)

8
Regressions explaining the percentage of the
urban population infected with HIV (1)
9
Regressions explaining the percentage of the
urban population infected with HIV (2)
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Regressions explaining the percentage of the
urban population infected with HIV (2)
11
GNP per Capita, Income Inequality and Urban Adult
HIV Infection72 Developing Countries
Urban adult HIV prevalence
35
35
0
Botswana
0
0
Zimbabwe
0
0
Zambia
Guyana
0
Haiti
0
0
Guyana
0
0
0
20
0
0
Zimbabwe
20
0
0
0
0
0
Botswana
0
0
0
0
0
0
0
0
0
Zambia
0
0
0
Haiti
0
0
0
Rep. of Korea
0
0
0
0
0
0
Rep. of Korea
Honduras
0
Malawi
0
0
0
0
0
0
0
0
0
Spain
0
0
0
Malawi
Thailand
0
0
0
0
0
0
0
0
0
0
0
0
0
Honduras
0
Lao PDR
0
0
5
0
0
0
0
0
0
5
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Lao PDR
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Thailand
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Pakistan
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Spain
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
India
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
0
1
0
0
b
0
0
0
0
0
0
0
0
0
ARE
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
b
0
0
0
ARE
0
0
0
0
0
0
China
China
0
0
.01
0
0
0
.01
1,100
3,000
8,100
.3
.4
.5
.6
GNP per capita (1994 US)
Inequality of income distribution
12
Conclusions from the regressions explaining urban
HIV infection

• Poverty and income inequality facilitate spread
  of AIDS
• Gender inequality facilitates spread
• High risk groups drive the epidemic
• Soldiers
• Sex workers

13
Policy Recommendations

• 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
• 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

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Web Site of the International AIDS Economic
Network

• www.worldbank.org/aids-econ/