Poverty and underdevelopment are the key to understanding why developing countries have higher rates of infection and mortality from HIV/AIDS than developed countries.
Let’s look at poverty first. One way of viewing poverty is as a lack of income and consumption. This most obviously manifests itself as an inadequate diet and poor health, but it also means having insufficient income to buy condoms to protect oneself from infection. But poverty is much more than a lack of income. It takes the form of a multitude of other deprivations which prevent the poor exercising control over their bodies and lives. A lack of education means that HIV mothers are often unaware of the risk of passing on the infection to their babies through breast-milk, and even when they have this knowledge, the inability to read means they are unable to follow written instructions on how to reconstitute formula milk. This, of course, is compounded by having inadequate access to clean water.
The poor may also not be able to protect themselves because they lack the power to avoid exposing themselves. This is particularly manifest for women in choosing sexual partners. Poverty forces people to take risks and gender inequality means that women face these life challenges more frequently than men. There is evidence that domestic violence is increasing in Uganda because women are fearful of catching HIV from their partners and are refusing sex, or insisting on the use of condoms.
Underdevelopment is another reason for the higher rates of HIV/AIDS in developing countries. Developing country governments are struggling to provide some of the public goods we in the developed world take for granted such as free and accessible health care, universal primary education, electrification, clean water and sanitation. Prioritising HIV/AIDS over these pressing issues, or even within the slim health care budget, is a politically loaded decision that few developing country governments have been willing or able to take.
When the above is set against the background of the debt crisis of the 1980s, and the forced pace of economic liberalisation that has taken place in developing countries since, the full extent of the unfolding tragedy and global insensitivity comes into sharp relief.
The debt crisis of the 1980s came about because for much of the 1970s interest rates on borrowing money were low. This was because the oil exporting states like Saudi Arabia had plenty of surplus money following the oil price hike in 1973/4. They invested this money in international banks that then encouraged developing countries to borrow it at low interest rates to fuel their development spending. However, in the early 1980s, interest rates began to climb, and repayments began to spiral upwards for the borrowers in the developing world. A crisis was reached when a couple of big borrowers, Mexico and Brazil, threatened to cease repaying, or default, on their loans unless repayments were rescheduled on more concessionary terms. Rescheduling did take place, but to this day, debt repayments continue to drain the financial resources of many developing countries. For the last two decades many have been paying large chunks of their annual budgets in debt repayments to foreign banks and the International Monetary Fund and World Bank. This has starved their already weak health systems of vital resources. Thus, they were ill prepared for the added shock of HIV/AIDS. Some developing country health systems are on the verge of collapse. The economic stress has sometimes led to multiple use of needles and the failure to screen blood for the virus. Both have increased infection rates.
The prescription of the international financial community, spearheaded by the International Monetary Fund and World Bank, has been to force the pace of economic liberalisation in these countries. This has meant charging for services that were previously free, such as education and health care, putting them further out of the reach of the poor and compounding the problem of tackling HIV/AIDS. Indeed, it is no coincidence that 34 of the 42 World Bank designated Heavily Indebted Poor Countries are in Africa, all of whom, with the exception of Somalia, feature in the top 50 countries worst affected by the disease. Thus, as poverty and underdevelopment facilitate the spread of the virus, so HIV/AIDS exacerbates poverty and underdevelopment.