Publication: The Risks and Macroeconomic Impacts of HIV/AIDS in the Middle East and North Africa : Why Waiting to Intervene Can Be Costly
Loading...
Date
2002-08
ISSN
Published
2002-08
Author(s)
Editor(s)
Abstract
The authors develop a model of optimal growth to assess the risks of an HIV/AIDS epidemic and the expected economic impact in nine countries in the Middle East and North Africa region-Algeria, Djibouti, Egypt, Iran, Jordan, Lebanon, Morocco, Tunisia, and Yemen. The model incorporates an HIV/AIDS diffusion component based on two transmission factors-sexual intercourse and exchange of infected needles among intravenous drug users. Given high levels of uncertainty on the model parameters that determine the dynamics of the epidemic and its economic impact, the authors explore large regions of the parameter space. The prevalence rates in year 2015 would be below 1 percent in 16 percent of the cases, while they would be above 3 percent in 50 percent of the cases. On average, GDP losses across countries for 2000-2025 could approximate 35 percent of today's GDP. In all countries it is possible to observe scenarios where losses surpass today's GDP. The authors quantify the impact of expanding condom use and access to clean needles for intravenous drug users. They show that these interventions act as an insurance policy that increases social welfare. They also show that delaying action for five years can cost, on average, the equivalent of six percentage points of today's GDP.
Link to Data Set
Citation
“Jenkins, Carol; Robalino, David A.; El Maroufi, Karim. 2002. The Risks and Macroeconomic Impacts of HIV/AIDS in the Middle East and North Africa : Why Waiting to Intervene Can Be Costly. Policy Research Working Paper;No. 2874. © http://hdl.handle.net/10986/19265 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Publication Geopolitics and the World Trading System(Washington, DC: World Bank, 2024-12-23)Until the beginning of this century, the GATT/WTO system worked. Economic research provided a compelling explanation. It showed that if governments maximize the well-being of their own countries broadly defined, GATT/WTO principles would facilitate mutually beneficial cooperation over their trade policy choices. Now heightened geopolitical rivalry seems to have undermined the WTO. A simple transposition of the previous rationalization suggests that geopolitics and trade cooperation are not compatible. The paper shows that this is only true if rivalry eclipses any consideration of own-country well-being. In all other circumstances, there are gains from trade cooperation even with geopolitics. Furthermore, the WTO’s relevance is in question only if it adheres too rigidly to its existing rules and norms. Through measured adaptation to the geopolitical imperative, the WTO can continue to thrive as a forum for multilateral trade cooperation in the age of geopolitics.Publication The Macroeconomic Implications of Climate Change Impacts and Adaptation Options(Washington, DC: World Bank, 2025-05-29)Estimating the macroeconomic implications of climate change impacts and adaptation options is a topic of intense research. This paper presents a framework in the World Bank's macrostructural model to assess climate-related damages. This approach has been used in many Country Climate and Development Reports, a World Bank diagnostic that identifies priorities to ensure continued development in spite of climate change and climate policy objectives. The methodology captures a set of impact channels through which climate change affects the economy by (1) connecting a set of biophysical models to the macroeconomic model and (2) exploring a set of development and climate scenarios. The paper summarizes the results for five countries, highlighting the sources and magnitudes of their vulnerability --- with estimated gross domestic product losses in 2050 exceeding 10 percent of gross domestic product in some countries and scenarios, although only a small set of impact channels is included. The paper also presents estimates of the macroeconomic gains from sector-level adaptation interventions, considering their upfront costs and avoided climate impacts and finding significant net gross domestic product gains from adaptation opportunities identified in the Country Climate and Development Reports. Finally, the paper discusses the limits of current modeling approaches, and their complementarity with empirical approaches based on historical data series. The integrated modeling approach proposed in this paper can inform policymakers as they make proactive decisions on climate change adaptation and resilience.Publication Global Poverty Revisited Using 2021 PPPs and New Data on Consumption(Washington, DC: World Bank, 2025-06-05)Recent improvements in survey methodologies have increased measured consumption in many low- and lower-middle-income countries that now collect a more comprehensive measure of household consumption. Faced with such methodological changes, countries have frequently revised upward their national poverty lines to make them appropriate for the new measures of consumption. This in turn affects the World Bank’s global poverty lines when they are periodically revised. The international poverty line, which is based on the typical poverty line in low-income countries, increases by around 40 percent to $3.00 when the more recent national poverty lines as well as the 2021 purchasing power parities are incorporated. The net impact of the changes in international prices, the poverty line, and new survey data (including new data for India) is an increase in global extreme poverty by some 125 million people in 2022, and a significant shift of poverty away from South Asia and toward Sub-Saharan Africa. The changes at higher poverty lines, which are more relevant to middle-income countries, are mixed.Publication Global Socio-economic Resilience to Natural Disasters(Washington, DC: World Bank, 2025-05-22)Most disaster risk assessments use damages to physical assets as their central metric, often neglecting distributional impacts and the coping and recovery capacity of affected people. To address this shortcoming, the concepts of well-being losses and socio-economic resilience—the ability to experience asset losses without a decline in well-being—have been proposed. This paper uses microsimulations to produce a global estimate of well-being losses from, and socio-economic resilience to, natural disasters, covering 132 countries. On average, each $1 in disaster-related asset losses results in well-being losses equivalent to a $2 uniform national drop in consumption, with significant variation within and across countries. The poorest income quintile within each country incurs only 9% of national asset losses but accounts for 33% of well-being losses. Compared to high-income countries, low-income countries experience 67% greater well-being losses per dollar of asset losses and require 56% more time to recover. Socio-economic resilience is uncorrelated with exposure or vulnerability to natural hazards. However, a 10 percent increase in GDP per capita is associated with a 0.9 percentage point gain in resilience, but this benefit arises indirectly—such as through higher rate of formal employment, better financial inclusion, and broader social protection coverage—rather than from higher income itself. This paper assess ten policy options and finds that socio-economic and financial interventions (such as insurance and social protection) can effectively complement asset-focused measures (e.g., construction standards) and that interventions targeting low-income populations usually have higher returns in terms of avoided well-being losses per dollar invested.Publication From Patriarchy to Policy(Washington, DC: World Bank, 2025-05-29)Legal institutions play an important role in shaping gender equality in economic domains, from inheritance to labor markets. But where do gender equal laws come from? Using cross-country data on social norms and legal equality, this paper investigates the socio-cultural roots of gender inequity in the legal system and its implications for female labor force participation. To identify the impact of social norms, the analysis uses an empirical strategy that exploits pre-modern differences in ancestral patriarchal culture as an instrument for present-day gender norms. The findings show that ancestral patriarchal culture is a strong predictor of contemporary norms, and conservative social norms are associated with more gender inequality in the de jure legal framework, the de facto implementation of laws, and the labor market. The paper presents evidence for a political selection mechanism linking norms to laws: countries with more conservative norms elect political leaders who are more hostile to gender equality, who then pass less progressive legislation. The results highlight the cultural roots and political drivers of legalized gender inequality.
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication HIV/AIDS in the Middle East and North Africa : The Costs of Inaction(Washington, DC: World Bank, 2003)This book reviews the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) situation in the Middle East, North Africa, and Eastern Mediterranean (MENA/EM) region, and is intended to stimulate discussion and promote dialogue among the region's policy and decisionmakers. It seeks to provide a framework for multisectoral strategic action to reduce behaviors that risk spreading HIV, to care for and support those who become infected, and to diminish vulnerability among specific segments of society. Although most evidence suggests that overall HIV prevalence is low in the region, greater investments in improved surveillance, and care needed now-to maintain low prevalence levels and preserve the focus on national and regional development goals.Publication The Economics of Effective AIDS Treatment : Evaluating Policy Options for Thailand(Washington, DC: World Bank, 2006)The purpose of this report is to advise the Thai government and Thai society at large about the full range of benefits, costs, and consequences that are likely to result from the decision to expand public provision of antiretroviral therapy (ART) through National Access to Antiretroviral Program for People Living with HIV/AIDS (NAPHA) and to assist with the design of implementation policies that will achieve maximum treatment benefits, while promoting prevention of HIV/AIDS and maintaining financial sustainability within Thailand. The study has several significant findings: NAPHA with first-line regimen only is the most cost-effective policy option of those studied; NAPHA with second-line therapy is still affordable and yields large benefits in terms of life-years saved; policy options to enhance adherence and to recruit patients earlier are a good public investment; public financing will help ensure equitable access; public financing can strengthen positive spillovers and can limit negative spillovers of ART; if the success of ART rollout makes people or the government complacent about prevention, future costs could rise substantially; and future government expenditures on ART, and the lives it will save are highly sensitive to negotiated agreements on the intellectual property rights for pharmaceuticals. In its current form, Thailand's NAPHA program is affordable. Under the model's assumptions, it is also cost-effective relative to the baseline scenario. Furthermore, although the two enhanced policies we suggest early recruitment through expanded voluntary counseling and testing (VCT) and improved adherence through Person living with HIV/AIDS (PHA) groups are less cost-effective, they are still a good bargain, particularly if both are enacted.Publication HIV and AIDS in South Asia : An Economic Development Risk(World Bank, 2009)This book offers an original perspective on HIV and AIDS as a development issue in South Asia, a region with a heterogeneous epidemic and estimated national HIV prevalence rates of up to 0.5 percent. The analysis challenges the common perception of HIV and AIDS, which has been shaped to a large extent by analysis of HIV and AIDS in regions with much higher prevalence rates. The chapters, most of which were commissioned specifically for this volume, can be grouped in three broad themes - the epidemiology of HIV and prevention strategies (chapters one and two), economic and development impacts of HIV and AIDS (chapters three and four), and the implications of HIV and AIDS for the health sector (chapters five and six). Within each theme, one chapter provides a more general discussion of the respective issues in the region (chapters one, three, and five), and one chapter highlights aspects of the respective issue in one particular country (with chapter two dealing with HIV in Afghanistan, and chapters four and six discus sing aspects of the impact of or the response to HIV and AIDS in India). Regarding the broad development themes identified by this book, chapters one and two highlight the epidemiological risks. Chapter three surveys the intersection of HIV and AIDS and key development objectives, and is complemented by chapters four and five. The forward-looking discussion of the challenges of scaling up (chapter five) is complemented by an analysis of the costs of antiretroviral treatment (ART) in India (chapter six) and a cross-country analysis of access to treatment (in chapter three).Publication HIV/AIDS in Southeastern Europe : Case Studies from Bulgaria, Croatia, and Romania(Washington, DC: World Bank, 2003-05)In June 2002, the countries of Southeastern Europe (SEE) recommitted themselves to scale up action on the prevention and treatment of Human Immunodeficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS). Given the rapid increase in the rate of HIV infection in Eastern Europe in general, and the generally similar risk conditions for low HIV prevalence SEE populations, this commitment is timely in terms of preventing a more widespread epidemic. It should also be recognized by the World Bank as a call to action to support these countries through the application of its comparative advantage in both lending and non-lending activities. The purpose of this paper is to review the current status of the AIDS epidemics in three countries of the Sub-region (Bulgaria, Croatia, and Romania - which constitute the ECC05 Country Department of the World Bank), to evaluate the approaches and strategies currently being used in each country, and to make recommendations both for government strategies and for the Bank's current and potential future involvement in relation to these strategies. The current low levels of HIV infection in SEE present a challenge in gaining recognition of the potential impact of HIV/AIDS on health systems, social structures, and individuals. Moreover, the approach to HIV/AIDS in SEE is complicated by relatively high levels of stigma against vulnerable groups (intravenous drug users [IDU], commercial sex workers [CSW], ethnic minorities such as the Roma, mobile populations, and men who have sex with men [MSM]).Publication Swaziland - HIV Prevention Response and Modes of Transmission Analysis(World Bank, 2009-03-01)The purpose of this modes of transmission (MoT) study is 'to contribute to the ongoing efforts to understand the epidemic and response in Swaziland and thus help the country improve the scope (doing the right kind of activities), relevance (with the right populations), and comprehensiveness (reaching all members of target populations) of Human Immunodeficiency Virus (HIV) prevention efforts'. The process for the Know Your Epidemic (KYE) was an in-depth review of available epidemiological data from Swaziland and the sub-region, and application of the UNAIDS incidence estimation model. The aim was to determine the epidemiology of new (incident) infections. For the Know Your Response (KYR) part, data were collected on the policy context for prevention, prevention and prevention activities by implementers, and data from the National AIDS Spending Assessment (NASA) of 2008 were reviewed. In a final step, the KYE and KYR evidence was linked to produce an epidemic, response and policy synthesis with recommendations to improve the HIV prevention response through aligning prevention activities with the evidence on the sources of new infections. The study examined the hypothesis that multiple, concurrent long-term heterosexual relationships, happening in a context of implicitly permissive social norms, gender inequality and economic need, are a key contributor to HIV transmission in Swaziland.
Users also downloaded
Showing related downloaded files
Publication Governance Matters IV : Governance Indicators for 1996-2004(World Bank, Washington, DC, 2005-06)The authors present the latest update of their aggregate governance indicators, together with new analysis of several issues related to the use of these measures. The governance indicators measure the following six dimensions of governance: (1) voice and accountability; (2) political instability and violence; (3) government effectiveness; (4) regulatory quality; (5) rule of law, and (6) control of corruption. They cover 209 countries and territories for 1996, 1998, 2000, 2002, and 2004. They are based on several hundred individual variables measuring perceptions of governance, drawn from 37 separate data sources constructed by 31 organizations. The authors present estimates of the six dimensions of governance for each period, as well as margins of error capturing the range of likely values for each country. These margins of error are not unique to perceptions-based measures of governance, but are an important feature of all efforts to measure governance, including objective indicators. In fact, the authors give examples of how individual objective measures provide an incomplete picture of even the quite particular dimensions of governance that they are intended to measure. The authors also analyze in detail changes over time in their estimates of governance; provide a framework for assessing the statistical significance of changes in governance; and suggest a simple rule of thumb for identifying statistically significant changes in country governance over time. The ability to identify significant changes in governance over time is much higher for aggregate indicators than for any individual indicator. While the authors find that the quality of governance in a number of countries has changed significantly (in both directions), they also provide evidence suggesting that there are no trends, for better or worse, in global averages of governance. Finally, they interpret the strong observed correlation between income and governance, and argue against recent efforts to apply a discount to governance performance in low-income countries.Publication Government Matters III : Governance Indicators for 1996-2002(World Bank, Washington, DC, 2003-08)The authors present estimates of six dimensions of governance covering 199 countries and territories for four time periods: 1996, 1998, 2000, and 2002. These indicators are based on several hundred individual variables measuring perceptions of governance, drawn from 25 separate data sources constructed by 18 different organizations. The authors assign these individual measures of governance to categories capturing key dimensions of governance and use an unobserved components model to construct six aggregate governance indicators in each of the four periods. They present the point estimates of the dimensions of governance as well as the margins of errors for each country for the four periods. The governance indicators reported here are an update and expansion of previous research work on indicators initiated in 1998 (Kaufmann, Kraay, and Zoido-Lobat 1999a,b and 2002). The authors also address various methodological issues, including the interpretation and use of the data given the estimated margins of errors.Publication Measuring Financial Inclusion : The Global Findex Database(World Bank, Washington, DC, 2012-04)This paper provides the first analysis of the Global Financial Inclusion (Global Findex) Database, a new set of indicators that measure how adults in 148 economies save, borrow, make payments, and manage risk. The data show that 50 percent of adults worldwide have an account at a formal financial institution, though account penetration varies widely across regions, income groups and individual characteristics. In addition, 22 percent of adults report having saved at a formal financial institution in the past 12 months, and 9 percent report having taken out a new loan from a bank, credit union or microfinance institution in the past year. Although half of adults around the world remain unbanked, at least 35 percent of them report barriers to account use that might be addressed by public policy. Among the most commonly reported barriers are high cost, physical distance, and lack of proper documentation, though there are significant differences across regions and individual characteristics.Publication Governance Matters VIII : Aggregate and Individual Governance Indicators 1996–2008(2009-06-01)This paper reports on the 2009 update of the Worldwide Governance Indicators (WGI) research project, covering 212 countries and territories and measuring six dimensions of governance between 1996 and 2008: Voice and Accountability, Political Stability and Absence of Violence/Terrorism, Government Effectiveness, Regulatory Quality, Rule of Law, and Control of Corruption. These aggregate indicators are based on hundreds of specific and disaggregated individual variables measuring various dimensions of governance, taken from 35 data sources provided by 33 different organizations. The data reflect the views on governance of public sector, private sector and NGO experts, as well as thousands of citizen and firm survey respondents worldwide. The authors also explicitly report the margins of error accompanying each country estimate. These reflect the inherent difficulties in measuring governance using any kind of data. They find that even after taking margins of error into account, the WGI permit meaningful cross-country comparisons as well as monitoring progress over time. The aggregate indicators, together with the disaggregated underlying indicators, are available at www.govindicators.org.Publication Design Thinking for Social Innovation(2010-07)Designers have traditionally focused on enchancing the look and functionality of products.