And would alternative policies deliver in the fight against HIV/AIDS?

This is what Rick Rowden, Senior Policy Analyst at ActionAid International USA, puts forward in his book “The Deadly Ideas of Neoliberalism: How the IMF has Undermined Public Health and the Fight Against AIDS”.

I have not read the book yet but went to the recent UK launch organised by the publisher Zed at the SOAS in London. I can only report on my first impressions about the thesis that IMF policies, by constraining and limiting health policies and budgets in poor countries, affected the response to the HIV epidemic to the point that “Neoliberalism kills”.

Rick Rowden was convincing when explaining that IMF policies did have an impact on how developing countries could and decided to invest money lent by the fund (which is not in the HIV prevention business as he rightly noted). This is something that can hardly be disputed. But then, when asked if he could develop on the link he made between these economic policies and the HIV epidemic, and more importantly how alternatives policies would do better, Rowden presented a much less articulated argument.

Building on the fact that if developing countries had more control over IMF loans and were able to invest more in health and education, and therefore have more doctors, nurses and teachers, then this would help fighting HIV.

Some don’t share his analysis and there are some evidences to temper this reasoning. Let’s look at Chile, the laboratory of the Chicago Boys and their neo-liberal policies in the 80’s. Despite a resounding failure to succeed in lifting Chile out of poverty, the prevalence of HIV in the country in 2008 was 0.3%. That is 30 times less than in Nigeria another country badly treated than by the IMF and neoliberal principles, 60 times less than in South Africa were a leading cause of the epidemics has been presidential denialism, and 80 times less than in Botswana a country that has been rather successful economically.

The point here is that if external economic policies dictated by the IMF certainly played a role in the overall economic development of a country, the argument that they directly affected the HIV epidemics is rather flimsy. Several countries were rather successful at curbing the epidemic whilst having to deal with bad economic policies (imposed or not by the IMF).  Lest we forget, Uganda, Botswana, Thailand, and The Philippines, in their own ways, have experienced success where other were failing and are still failing.

In this context advocating alternative economic policies for the sake of advocating alternatives does not make great sense. Advocating policies that will deliver in the fight against HIV will, and these do not always have to be economic policies. Policies must be based on evidences and in the case of HIV on what is needed. And that’s where it is becoming complicated because different countries have different needs because they have different HIV epidemics, e.g. heterosexual in Sub-Saharan Africa, mostly MSM and IDUs in South and far east Asia, IDUs in Russia. Even within one country different epidemics can coexist and require different responses. Therefore, in some countries, policies will indeed need to address capacity building to deal with the epidemic, in other it will be to provide human rights, in some it will be behaviour change, but in many, it will be a mix of all of these.

Policies that give more freedom to developing countries to invest in health and education do not guarantee that receiving government will actually decide to do so, and here again we would find the Fund in a coercive position. Then, would having more doctors and nurses be the answer when in a country like South Africa a major issue is first to get people to test for HIV and second for those who test positive and need treatment to accept receiving it; providing it is much more down the road (see Jonny Steinberg’s book for more on this).

I am looking forward to read Rick Rowden’s book and I am sure he will be pretty convincing when it comes to the detrimental effect of IMF policies on education and health systems in developing countries. I am also looking forward to see how much, in his view, IMF neoliberal policies affected the development of the HIV epidemic and I am definitively curious to know what kind of alternatives will be put forward and their depth of action.

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