Cultural obstacles to the rollout of antiretrovirals: an exploratorycross-country analysis

Abstract

This article begins with an econometric analysis of potential socioeconomic determinants of highly active antiretroviral treatment (HAART) coverage. It shows that ‘cultural’ factors such as language diversity pose challenges to HAART coverage, but that the most important drivers of HAART coverage are: region (notably, living in the hyper-epidemic region of southern Africa) and access to government and donor funding. These economic determinants, however, are underpinned by a further cultural dimension—namely public and donor attitudes towards HIV/AIDS funding. The second part of the article turns to the issue of ‘donor culture.’ It describes the sea change in attitudes which underpinned the growth in funding for HIV/AIDS and points to the growing backlash against HIV/AIDS funding in which claims are being made that HIV/AIDS has received a greater share of funding than warranted by its contribution to the overall disease burden, and that Africans themselves would prefer HIV/AIDS resources to be allocated to other development objectives. The article argues that neither assertion is supported by the available evidence and that opinion data from the Afrobarometer surveys suggest that high levels of support exist within Africa for continued spending on health and HIV/AIDS, even in the presence of other challenges.

Keywords:

• development policy
• development theories
• donors
• economics
• fractionalisation indexes
• funding
• health financing
• HIV/AIDS
• socio-cultural aspects
• socioeconomic factors
• southern Africa

Notes

1 These are Angola, Argentina, Barbados, Belize, Benin, Bolivia, Botswana, Brazil, Burkina Faso, Burundi, Cambodia, Cameroon, Central African Republic, Chad, Chile, China, Colombia, Congo, Costa Rica, Cote d’Ivoire, Democratic Republic of the Congo, Djibouti, Dominican Republic, Ecuador, Egypt, Eritrea, Ethiopia, Gabon, Gambia, Ghana, Guatemala, Guinea, Guyana, Honduras, India, Indonesia, Iran, Jamaica, Kazakhstan, Kenya, Latvia, Lesotho, Madagascar, Malawi, Malaysia, Mali, Mauritania, Mexico, Mozambique, Myanmar, Namibia, Nepal, Nicaragua, Niger, Nigeria, Pakistan, Papua New Guinea, Paraguay, Peru, Philippines, Russia, Senegal, South Africa, Sri Lanka, Suriname, Swaziland, Thailand, Togo, Trinidad and Tobago, Uganda, Ukraine, Tanzania, Uruguay, Uzbekistan, Vietnam, Zambia and Zimbabwe.

2 These are: Botswana, Cote d’Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Vietnam and Zambia.

3 See: <http://www.un.org/ga/aids/pdf/abuja_declaration.pdf>.

4 UNAIDS no longer publishes HAART coverage data as the measure depends on whether treatment is initiated at counts below 350 or below 200 CD4 cells/μL. About 5 million people are now on HAART in middle-income and developing countries. This represents between one-third to one-half of those needing it, depending on how need is defined.

5 See report from the XVIII International AIDS Conference, Vienna, July 2010: <http://aidsmap.com/page/1492728/>.