However, the structural adjustment program, which has been commonly

However,
in a contrasting perspective, the frequent application of neoliberal policies
applied in low-income countries, recent research has identified a potential
link with the HIV/AIDS epidemic (Lester, 2017). Various global organisations
have been criticised in their response to the disease in an attempt to understand
the potential link. Associations such as; health, commercial sex, poverty,
labour migration etc. have been explored and identified as primary issues that
are influencing the epidemic (Lester, 2017). Affecting the majority of
countries, neoliberalism is considered a philosophy equally as it is an
economic structure. Anderson (2000) describes neoliberalism as “the most
successful ideology in world history”, which allows the examination of
healthcare, taxation, macroeconomic policy etc. Despite the general acceptance
that neoliberalism has become a vital part of the global context, there is also
an increasing amount of criticism (Campbell & Pederson, 2001) and this
theory is yet to present strengths in regards to HIV/AIDS (Lester, 2017). The
theory of neoliberalism aims to enhance the availability of control within the
public sector in comparison to private. A common neoliberal policy is the
structural adjustment program, which has been commonly used to improve the
economic structure of a population by the World Bank and IMF (Lester, 2017). A
common theme identified throughout HIV/AIDS prevention research in low-come
research is lack of financial support for medicine, health care workers and
doctors. Research blames the cuts in national budgets on policies formed by
neoliberalism.

            Particularly in Africa, the World
Bank and IMF have made substantial additions to neoliberal policies, by promoting
free trade and taxation policies. Such institutions were firstly formed by
governments, with a primary aim to support global economy and balance growth.
Over time, authority has been gained through shareholders allowing the
institutions to become independent (Lester, 2017). The withdrawal of funding
from the health sector for example has been a mutual debated issue, as often
the sectors generate no direct economic benefits, and treatment and preventions
suffer and as a result disease prevalence increases. Woods (2006) suggested
that this particular failure within the World Bank and the IMF is primarily
reliant on the governmental influencing roles which controls agenda and the
actions of institutions. Therefore, with this in mind, the overall verdicts
decided are based on what the powerful actors can gain rather than with the needs
of the vulnerable in mind (Lester, 2017).

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The World Bank also plays an important
role as one of the leading development organisations for international health
and for the global response to HIV/AIDS. The organisation is a unique global
corporation which consists of 189 countries, offices in over 130 areas and
staff from over 170 countries (World Bank, 2018). The World Bank aims decrease
poverty prevalence by promotion economic development in low-income countries by
forming sustainable solutions (World Bank, 2018). Various structural adjustment
programs introduced in the early 1990’s encouraged by the World Bank and the
International Monetary Fund were disapproved by critics due to the recurrent
negative consequences (Parker, 2002). In response to this, the World Bank World
Development Report (1993) stated that attention was focused on issues relating
to health; increasing the availability of resources and new lending schemes, in
hope this introduces new projects concentrating on common developing word
issues (Parker, 2002). The organisation has also been visibly committed to
responding to the HIV/AIDS pandemic (World Bank, 1997). The international
financial institution provided a total of $1.7 billion in loans to developing
countries available for HIV/AIDS related work by the start of 2001, which by
that time was a vital financial resource in order to globally attempt to fight
against the epidemic (Parker, 2002).

However, critics are questioning their
increasing part in international health, despite the obvious importance of the
provided resources. An overall decline in spending for welfare programs,
education and health has occurred due to structural adjustment policies. These
policies have further been held partly responsible for contributing to the
HIV/AIDS epidemic in sub-Saharan Africa (Parker, 2002). A topic of which has been
a foremost focus of discussion in past years. Whiteford and Manderson (2000)
identified a cause for concern that the World Bank is increasingly appearing to
oppose the World Health Organisation despite it being considered as the most
dominant worldwide organisation involved in health work (Parker, 2002). In
addition to this, it is often forgotten that although a large sum of money was invested
by the World Bank to help confront the HIV/AIDS epidemic, they are still only
loans and not donations (Parker, 2002). Despite that the loans are often agreed
with fair interest rates, developing countries are already obliged to commit a
large proportion of their annual gross national products to pay of previously
agreed loans. The addition of the loans from the World Bank are now being
considered to contribute to the already increasing debt of many low-income
countries, therefore donations should be considered (Parker, 2002). The wider
problems of already existing debt levels in low income countries must be
considered and addressed by these organisations to develop a better
understanding of the economic and social growth in association to public
health. In both the North and South, a call has been made by treatment
campaigners, as they protest this is the only solution to increase public
health budgets in developing countries. By doing so, they hope this will allow
and 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 to
manageable levels, partially in response to debt crisis (Rowden et al., 2004). However,
as a result the overall national spending experienced a substantial cut, thus
affecting health budgets of many low-income countries. A UNICEF supported study
completed in 2004 concluded by 1987, a combination of; increase interest
payments, increase trading costs, cuts in social spending and overall global
economic recessions had resulted in basic indicators of child welfare as
education, immunisation and nutrition (Labonte & Schrecker, 2004, Rowden,
2004).