Has Better Health Care Contributed to Higher HIV Prevalence in Sub-Saharan Africa?

HIV/AIDS is a disease for which we ourselves are the vector. Consequently, a high prevalence of the disease in the population is likely to generate a high incidence of new infections. This paper argues that in Sub-Saharan Africa, where the prevalence of other fatal diseases is high, there is a counter-intuitive effect of health care spending: such spending increases the life expectancy of the infected, and so drives up the prevalence of HIV in the population. The link between prevalence and incidence implies that high-quality health care may thus inadvertently increase HIV transmission, leading to elevated HIV prevalence in the course of an epidemic. JEL Classifications: I12, H51, O55. * Graduate School of International Relations and Pacific Studies, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093-0519, e-mail: [email protected]. Thanks to Jean Ensminger, Takeo Hoshi, Ted Miguel, Tom Novotny, Dan Posner, Steffanie Strathdie, and seminar participants at Yale, the Working Group on African Political Economy, and the UCSD Medical Center Clinical Rounds for helpful suggestions, and to Christina Murray, Tara Ramanathan and Jacob Allen for excellent research assistance. All remaining errors are my own.