However,in a contrasting perspective, the frequent application of neoliberal policiesapplied in low-income countries, recent research has identified a potentiallink with the HIV/AIDS epidemic (Lester, 2017). Various global organisationshave been criticised in their response to the disease in an attempt to understandthe potential link. Associations such as; health, commercial sex, poverty,labour migration etc.
have been explored and identified as primary issues thatare influencing the epidemic (Lester, 2017). Affecting the majority ofcountries, neoliberalism is considered a philosophy equally as it is aneconomic structure. Anderson (2000) describes neoliberalism as “the mostsuccessful ideology in world history”, which allows the examination ofhealthcare, taxation, macroeconomic policy etc. Despite the general acceptancethat neoliberalism has become a vital part of the global context, there is alsoan increasing amount of criticism (Campbell & Pederson, 2001) and thistheory is yet to present strengths in regards to HIV/AIDS (Lester, 2017). Thetheory of neoliberalism aims to enhance the availability of control within thepublic sector in comparison to private. A common neoliberal policy is thestructural adjustment program, which has been commonly used to improve theeconomic structure of a population by the World Bank and IMF (Lester, 2017).
Acommon theme identified throughout HIV/AIDS prevention research in low-comeresearch is lack of financial support for medicine, health care workers anddoctors. Research blames the cuts in national budgets on policies formed byneoliberalism. Particularly in Africa, the WorldBank and IMF have made substantial additions to neoliberal policies, by promotingfree trade and taxation policies. Such institutions were firstly formed bygovernments, with a primary aim to support global economy and balance growth.Over time, authority has been gained through shareholders allowing theinstitutions to become independent (Lester, 2017). The withdrawal of fundingfrom the health sector for example has been a mutual debated issue, as oftenthe sectors generate no direct economic benefits, and treatment and preventionssuffer and as a result disease prevalence increases. Woods (2006) suggestedthat this particular failure within the World Bank and the IMF is primarilyreliant on the governmental influencing roles which controls agenda and theactions of institutions. Therefore, with this in mind, the overall verdictsdecided are based on what the powerful actors can gain rather than with the needsof the vulnerable in mind (Lester, 2017).
The World Bank also plays an importantrole as one of the leading development organisations for international healthand for the global response to HIV/AIDS. The organisation is a unique globalcorporation which consists of 189 countries, offices in over 130 areas andstaff from over 170 countries (World Bank, 2018). The World Bank aims decreasepoverty prevalence by promotion economic development in low-income countries byforming sustainable solutions (World Bank, 2018).
Various structural adjustmentprograms introduced in the early 1990’s encouraged by the World Bank and theInternational Monetary Fund were disapproved by critics due to the recurrentnegative consequences (Parker, 2002). In response to this, the World Bank WorldDevelopment Report (1993) stated that attention was focused on issues relatingto health; increasing the availability of resources and new lending schemes, inhope this introduces new projects concentrating on common developing wordissues (Parker, 2002). The organisation has also been visibly committed toresponding to the HIV/AIDS pandemic (World Bank, 1997). The internationalfinancial institution provided a total of $1.7 billion in loans to developingcountries available for HIV/AIDS related work by the start of 2001, which bythat time was a vital financial resource in order to globally attempt to fightagainst the epidemic (Parker, 2002). However, critics are questioning theirincreasing part in international health, despite the obvious importance of theprovided resources.
An overall decline in spending for welfare programs,education and health has occurred due to structural adjustment policies. Thesepolicies have further been held partly responsible for contributing to theHIV/AIDS epidemic in sub-Saharan Africa (Parker, 2002). A topic of which has beena foremost focus of discussion in past years. Whiteford and Manderson (2000)identified a cause for concern that the World Bank is increasingly appearing tooppose the World Health Organisation despite it being considered as the mostdominant worldwide organisation involved in health work (Parker, 2002).
Inaddition to this, it is often forgotten that although a large sum of money was investedby the World Bank to help confront the HIV/AIDS epidemic, they are still onlyloans and not donations (Parker, 2002). Despite that the loans are often agreedwith fair interest rates, developing countries are already obliged to commit alarge proportion of their annual gross national products to pay of previouslyagreed loans. The addition of the loans from the World Bank are now beingconsidered to contribute to the already increasing debt of many low-incomecountries, therefore donations should be considered (Parker, 2002).
The widerproblems of already existing debt levels in low income countries must beconsidered and addressed by these organisations to develop a betterunderstanding of the economic and social growth in association to publichealth. In both the North and South, a call has been made by treatmentcampaigners, as they protest this is the only solution to increase publichealth budgets in developing countries. By doing so, they hope this will allowand increase the application of suitable treatment and care programs (Parker,2002).The World Bank and IMF introduced’structural adjustment’ loan conditions which were aimed to reduce inflation tomanageable levels, partially in response to debt crisis (Rowden et al., 2004).
However,as a result the overall national spending experienced a substantial cut, thusaffecting health budgets of many low-income countries. A UNICEF supported studycompleted in 2004 concluded by 1987, a combination of; increase interestpayments, increase trading costs, cuts in social spending and overall globaleconomic recessions had resulted in basic indicators of child welfare aseducation, immunisation and nutrition (Labonte & Schrecker, 2004, Rowden,2004).