Abstract
Since the appearance of the human immunodeficiency virus (HIV) more than 25 years ago the virus has been spread all over the world, but unevenly. The concentration of HIV in developing countries is worrying because their governments are often reluctant to intervene. Those governments are faced with other important demands as addressing malnutrition which are competitive for scarce financial resources. Hence, their willingness to establish anti-AIDS programmes is little. The epidemiological, political and social consequences do not only become visible within developing countries, but also globally. This cross-country health interdependency has to be reflected in a worldwide response because isolated interventions do not seem to be effective in the long run. The concept of international public goods was suggested in the academic literature on AIDS to solve international concerns. Several governments and international organisations like the World Bank or the WHO have followed this recommendation by setting this topic on their agendas (World Bank 2000, pp. 2, 6; Engqvist 2001, p. 3). The WHO and the Joint United Nations Programme on HIV/AIDS (UNAIDS), for example, refer to the provision of HIV prevention as a classic public good intervention in their annual report about the AIDS epidemic in 2005 (UNAIDS and WHO 2005, p. 7). However, it seems that the provision of international public goods does not meet the requirement to result in effective policy responses in the fight against HIV/AIDS. Cross-country benefit and cost spillovers and the resulting difficulties in determining the corresponding prices imply that the control of HIV/AIDS tends to be suboptimal. In contrast to national health-promoting public goods as maintaining hospitals, there is no government that can intervene either by using taxes for financing or by direct provision (Smith et al. 2004, p. 272). This chapter shows why a consideration of international public goods with respect to the global AIDS epidemic is still justified.
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Notes
- 1.
Data of pregnant women are available because antenatal clinics are well-attended.
- 2.
High risk behaviour means unprotected sexual intercourse with many partners or sharing injecting equipment like unsterilised needles and syringes (Ainsworth and Over 1999, p. xxiv).
- 3.
USAID (2002, p. 7) further differentiates between so-called high prevalence countries in which more than 5% of people aged between 15 and 49 are infected with HIV and so-called low prevalence countries in which less than 5% of these people are HIV-positive.
- 4.
Epidemiological fact sheets are available for each country on the WHO Website: [http://www.who.int/globalatlas/default.asp].
- 5.
The impact of regional concerns on HIV/AIDS and its consequences on health policies is discussed in detail in Chap. 5.
- 6.
Estimate is based on 2005.
- 7.
PEPFAR which was announced in 2003 is a five-year initiative to address HIV/AIDS, tuberculosis and malaria by providing prevention, treatment and care (The Kaiser Family Foundation 2005, p. 8). On July 30, 2008, PEPFAR was renewed by law H.R. 5501, the Tom Lantos and Henry J. Hyde United States global leadership against HIV/AIDS, tuberculosis, and malaria reauthorization act (Congress of the United States of America, 2008).
- 8.
Other factors include endemic diseases like tuberculosis or malaria, armed conflicts or economic stagnation.
- 9.
The severity of a disease is measured on a scale from 0 representing perfect health to 1 implying death. More detailed information about severity weights can be found in the World Development Report 1993, pp. 26 ff.
- 10.
- 11.
Then, the question which multiple value of the GNI per capita is justified arises.
- 12.
In addition, an evaluation based on the GNI per capita indicates a higher priority for diseases in industrialised than in developing countries (Evans 2004, p. 121).
- 13.
Further causes are changes in population size and structures, urbanisation and poverty (Pallangyo 2001, p. 488).
- 14.
CD4+ or Tcells are white blood cells which protect a human´s body from an infection (Divisions of HIV/AIDS Prevention 2005, p. 3).
- 15.
Data are taken from the 2005 revision population data base and from the report of the International Organization for Migration (IOM 2008, p. 505).
- 16.
A consideration of the U.S. which has the highest number of immigrants is not possible. Even though HIV data among their population by race and ethnicity like American Indians, African Americans and Latinos are captured, there is no differentiation between foreign-born and U.S.-born people.
- 17.
Data for the European Union (EU) can be found in Hamers et al. (2006).
- 18.
In recent years, the number of Zimbabwean entrants has declined due to the introduction of visa requirements (NAM 2002).
- 19.
For a detailed discussion of allocative consequences of national health interventions see Chap. 3.
- 20.
Drug resistance is a natural biological phenomenon and cannot be circumvented.
- 21.
Home-based care aims at providing comprehensive health and social services, e.g. supporting family members’ care activities, transporting patients to hospitals, providing resources like soap, etc. (Lamptey et al. 2001, p. 39).
- 22.
As usual, the term “public” does not refer to the kind of provision. It characterises the degree of non-rivalry of consumption and non-excludability of consumers.
- 23.
An externality exists if an agent does not take the full marginal consequences of his action on other individuals into account.
- 24.
A detailed description of further classes of impure public goods can be found in Sandler and Arce (2002).
- 25.
Hirshleifer himself did not use the term “aggregation technology”. He defines it as social composition function (Hirshleifer 1983, p. 372). The expression “technology of public supply aggregation” is coined by Cornes and Sandler. See also Sandler and Sargent (1995, p. 152). Arce (2001, p. 115) labels it as contribution aggregator.
- 26.
However, if the interests of pharmaceutical companies to find a vaccine are low since purchasing power is lacking in low-and middle-income countries, the best-shot argument does not hold.
- 27.
There are further aggregation technologies like threshold or weighted sum. A threshold international public good is characterised by surpassing a threshold to receive benefits (Sandler 2001b, footnote 10). The weighted sum aggregation technology is a generalisation of the summation technology. In contrast to an additive technology, each contributor’s effort can have a different additive impact on the overall provision level.
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Sonntag, D. (2010). The Challenge: A Transnational Response to HIV/AIDS. In: AIDS and Aid. Contributions to Economics. Physica-Verlag HD. https://doi.org/10.1007/978-3-7908-2419-3_2
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