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Proposal for a Seminar on "Poverty and HIV/AIDS"
Organized by the IUSSP Working Group on Population and Poverty
Date of Proposal: December 5, 2003

Scientific Organizers:
David Lam, University of Michigan (davidl@umich.edu)
Murray Leibbrandt, University of Cape Town (mleibbra@commerce.uct.ac.za)

Other members of organizing committee:
John Strauss, Michigan State University
John Casterline, Population Council

Proposed Seminar Dates: October - November, 2005
Proposed Venue: Cape Town, South Africa
Potential Collaborating Organization: University of Cape Town

Theme of Seminar

The association between poverty and HIV/AIDS is a subject much debated by scientists and of deep concern to governments and donor agencies. A common assertion is that poverty has been an important facilitating factor in the spread of the epidemic. Another common assertion is that AIDS morbidity and mortality will be devastating to the economies in those countries most deeply affected by the epidemic. A related worry is that AIDS morbidity and mortality will (further) impoverish the affected households, and in so doing worsen economic inequality in the society as a whole. These assertions about the association between HIV/AIDS and poverty are credible, but they are based on a slim empirical research foundation. The goal of the seminar on "Poverty and HIV/AIDS" will be to strengthen the scientific basis for drawing conclusions about the association between poverty and HIV/AIDS and, thereby, developing appropriate policy and programmatic initiatives.

As is evident from the assertions above, the causal linkages between poverty and HIV/AIDS are probably multiple and complex. It is plausible that causation runs in both directions: poverty may have a direct impact on behaviors underlying the incidence of HIV/AIDS as well as behaviors mediating the prevention and treatment of HIV/AIDS; and, looking at causation in the other direction, the disability, medical expenses, and mortality resulting from the disease may push some households into poverty, depending on their capacity to make adjustments to this shock (which itself may vary with the poverty status of a household). It is also clear that the association has both macro-level and micro-level components. Accordingly, in developing the program for the seminar, papers on both macro and micro topics will be considered, although the emphasis will be on research exploring household-level interactions between HIV/AIDS and poverty because this level of analysis is less well-developed and brings to the fore issues of poverty. Submissions will be especially encouraged that are based on empirical analysis of micro-level data on individuals and households.

The seminar will focus on two major themes: (i) The impact of HIV/AIDS on the well-being of households and individuals. (ii) Poverty and the prevention and treatment of HIV/AIDS.

Impact of HIV/AIDS on the well-being of households and individuals.
Social scientists and other observers have posited that HIV/AIDS can affect the social and economic well-being of households and individuals through several mechanisms. These include changes in labor market status, changes in productivity in both labor market and non-labor market activities, and changes in the care-giving demands on household members. A particular concern of the seminar is whether and how these mechanisms differentially impact poor and non-poor households and individuals. Given differences between poor and non-poor households in terms of resources and the consequent capacity to make adjustments and smooth consumption, it is important to know whether an HIV/AIDS shock translates into different outcomes for poor and non-poor households? Household responses of interest would include school enrollment, labor market participation, changes in household living arrangements, and the re-allocation of agricultural and home production responsibilities. The seminar will be interested in questions such as the following: Does the employment of other household members adjust in response to disability and death of HIV-infected members? Are children pulled out of school? Is there evidence that households reconfigure themselves in response to an HIV/AIDS shock? Who bears the burden of caretaking for HIV-infected persons? Who cares for orphans and others dislocated by AIDS mortality? Is there evidence of migration of HIV-infected persons or potential caretakers as a response? What is the impact on consumption and intra-household allocation of resources? Does HIV/AIDS push households into poverty? To what extent do neighborhood and community factors affect the adjustment process? Is there evidence that the impacts and responses to an HIV/AIDS shock are similar to other shocks, especially other health shocks, or are there unique dimensions to HIV/AIDS shocks?

An important topic that is the focus of current research by economists is the macroeconomic and economy-wide impact of HIV/AIDS. This research has resulted in influential reports that have received widespread attention. But the research underlying these reports often is based on many largely unsubstantiated assumptions about the impact of HIV/AIDS on household and individual behavior. While macro studies of this type will be considered for presentation at the seminar, of higher priority will be research that enriches our understanding of the many micro linkages between HIV/AIDS and outcomes at the household and individual level. The findings from such studies, in turn, can play an important role in sharpening the foundations of the macroeconomic assessments of the impacts of HIV/AIDS. For example, the responses of firms as demanders of labor to increased HIV/AIDS prevalence or the impact of HIV/AIDS on labor productivity (in all spheres of economic activity) are both key issues of great significance to the impact of HIV/AIDS on poor individuals and households.

Poverty and the prevention and treatment of HIV/AIDS.
The second major theme of the seminar will be how poverty affects the prevalence of HIV/AIDS and its successful treatment. Of particular interest will be studies evaluating prevention behavior as well as studies exploring the uptake and impact of anti-retroviral treatment programs (ARVs). To what extent is poverty status correlated with different sexual risk taking behavior? What factors seem to affect the links between poverty status and risk taking behaviors? Is there evidence that the poor are less likely to participate in and make effective use of ARV treatment programs? Can studies single out specific factors that are key to successful treatment processes? In the light of this, what can be done to improve treatment processes?

Indicative of the importance of these and related questions, there has already been a great deal of discussion of these two themes. But rigorous scientific research is in short supply, especially research at the household level, where questions of poverty have special salience. The seminar will bring together researchers who are currently doing research in this area using a variety of data sources and research methodologies. The seminar will also encourage new high-quality research in this area by demonstrating methodologies that are effective in providing persuasive evidence about the links between poverty and HIV/AIDS.

It is expected that the seminar will have an African focus, but submissions from all regions will be welcomed. A number of impact studies have been undertaken and are being undertaken in Africa, and the seminar will make every effort to pull in key participants from across the continent. Preliminary evidence suggests that these current impact studies are of uneven quality, especially in terms of the design of the research. One of the goals of the seminar is to ensure that the best practice methodologies are highlighted and extensively discussed. To ensure this goal, the organizers will consider commissioning at least two review papers that focus on appropriate methodologies for assessing the impact of HIV/AIDS and for assessing the effectiveness of HIV/AIDS treatment regimes.

Structure of Seminar
In order to meet the twin goals of embracing a wide array of African researchers and ensuring adequate discussion of appropriate methodologies, the seminar will run over three days and will mix longer plenary papers with sessions in which research results from related sets of studies are presented and discussed. Consideration will be given to allowing poster presentations of projects that are still in the design phase. It is hoped that such a structure will provide a valuable stock-taking of the existing state of knowledge on these crucial issues along with structured opportunities for interactions that will improve the quality of the ongoing research. We expect that the number of participants would be in the range of 30-40, including 10-15 less experienced researchers who will be invited with the goal of building the capacity at African institutions for research in this area.

Proposed Venue and Collaborating Institution
The seminar would be held in Cape Town, South Africa. Cape Town has excellent and reasonably priced conference facilities, with convenient access by air from Africa and the rest of the world. The host institution would be the University of Cape Town (UCT). The Centre for Social Science Research (CSSR) at UCT has developed an AIDS and Society Research Unit (ASRU) that is doing work closely related to the themes of the workshop. The CSSR has excellent administrative staff that would provide support for organizing and hosting the event