HIV/AIDS continues to take a tremendous toll on the populations of
many countries, especially in sub-Saharan Africa. In some countries
with high HIV prevalence rates, life expectancy has declined by more
than a decade and in a few cases by more than two decades. Even in
countries with HIV prevalence of around 5 percent (close to the average
for sub-Saharan Africa), the epidemic can reverse gains in life
expectancy and other health outcomes achieved over one or two
This volume highlights work conducted under the umbrella of a World
Bank work program on 'The Fiscal Dimension of HIV/AIDS,'
including country studies on Botswana, South Africa, Swaziland, and
Uganda. It covers four aspects of the fiscal dimensions of
First, it aims for a comprehensive analysis of the fiscal costs of
HIV/AIDS, with a wider scope than a costing analysis focusing on only
the policy response to HIV/AIDS.
Second, it embeds the analysis of HIV/AIDS costs in a discussion of
the fiscal context, and interprets these costs as a quasi-liability,
not a debt de jure, but a political and fiscal commitment that binds
fiscal resources in the future and cannot easily be changed, and very
similar to a pension obligation or certain social grants or
Third, it develops tools to assess the (fiscal dimensions of)
trade-offs between HIV/AIDS policies and measures that take into
account the persistence of these spending commitments.
Fourth, most of the fiscal costs of HIV/AIDS are ultimately caused
by new infections, and this study estimates the fiscal resources
committed (or saved) by an additional (or prevented) HIV infection.
Building on these estimates, the analysis here is able to assess the
evolving fiscal burden of HIV/AIDS over time.
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