The role of the political economy in determining HIV and AIDS policies
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1 The role of the political economy in determining HIV and AIDS policies Taleski SJ 1, Ahmed K 2 & Whiteside A 2 1 Centre for International Health and HIV Social, Behavioural and Epidemiological Studies Unit, Dalla Lana School of Public Health, University of Toronto, Canada 2 Health Economics and HIV/AIDS Research Division, University of KwaZulu-Natal, South Africa IAEN 2010 July Vienna, Austria
2 Background Economic evaluations are necessary to 1. Make decisions about affordability 2. Assist in the efficient allocation of resources but not sufficient for intervention implementation. Political economy can dominate the policy sphere.
3 Modelling political economy Modelling PE Traditional statistical and econometric techniques Extensions to the standard economic tool-kit Structural equation modelling and factor analysis MDG-costing type models Data envelope analysis Data issues Availability and quality
4 Objective To investigate the role of the political economy in the facilitation or hindrance of HIV and AIDS national policy development.
5 Methods A comparative analysis of current and past HIV and AIDS policies by countries experiencing concentrated, but dissimilar, epidemics was conducted.
6 Global context Multilateral policy and programming Donor funds International economic context Global discourse in health Global events & actors National context Culture Religion Natural environment Government policies & actions Health policies & reforms National budget considerations Actions in other sectors Health system & other sectors Health service & public health infrastructure Research capacity & knowledge Education, labour and transportation sectors Civil society & Communities Community factors Civil society Social and behavioural factors Epidemiology & health outcomes Epidemiology of the HIV and epidemic General health status of the populations Epidemiology of other diseases HIV& AIDS outcomes Economic evaluations
7 Timeline Thailand: st AIDS case Thailand: 1987 Creation of National AIDS program Thailand: 1988 WHO provides technical and financial assistance China: st AIDS case Russia: st AIDS case Thailand: % Condom use campaign
8 Timeline Russia: 1991 Collapse of Soviet system, borders open & travel restrictions lifted Thailand: 1996 End of subsidised AZT monotherapy Russia: 2001 UNGASS Declaration of Commitment to HIV & AIDS signed Thailand: % Condom use campaign Thailand: 1992 Subsidised AZT monotherapy Thailand: 2001 Universal HIV & AIDS treatment Russia: Government spends 19 million USD/ yr on HIV & AIDS
9 Timeline Russia: Government spends 19 million USD/ yr on HIV & AIDS China: 2003 SARS outbreak, Four Free One Care China: 2006 First legislation directly aimed at controlling HIV &AIDS SARS (2003) Russia: 2005 Government announces 124USD million of oil stabilization fund to HIV treatment & prevention Globus project extended in Russia (2010)
10 Economic considerations Economics directly and indirectly affects HIV and AIDS policy development Availability of funding for treatment programmes in Thailand China implemented programming based on the cost-effectiveness of pilot programmes
11 Non-economic considerations Factors unrelated to funding that impact (non)implementation of standard HIV policies: Local research evidence Inter-sectoral government response Public health and health service infrastructure Exogenous factors Ideology
12 Figure 2: The interplay between political economy, economics and policy Driven by political economy Negative HIV & AIDS policies China Russia China Thailand Positive HIV & AIDS policies Russia Thailand Driven by economic considerations
13 Conclusions Interactions between Governance structures, Societal norms, and Religious-cultural beliefs can shape and determine HIV and AIDS policy. A political economy lens cognisant of the prevailing social, political and economic context should be used.
14 Ways forward Advancement of 1. Quantitative methodology 2. Conceptual frameworks 3. Knowledge transfer and exchange
15 Acknowledgements Funding Conference funding was received from HEARD SJT is supported by a CIHR doctoral award in the area of HIV and AIDS research
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