Date Published: October 23, 2007
Publisher: Public Library of Science
Author(s): Peter Piot, Robert Greener, Sarah Russell
Abstract: The authors discuss the “downstream” effects of AIDS on poverty, and the “upstream” effects of poverty upon acquiring HIV.
Partial Text: It is often asserted that AIDS is at the core of a “vicious circle”, whereby the impacts of AIDS increase poverty and social deprivation, while poverty and social deprivation increase vulnerability to HIV infection. In examining this view, it is important to distinguish between what might be called the “downstream” effects of AIDS on poverty, and the “upstream” effects of poverty upon the risk of acquiring HIV.
Generally speaking, there is a strong association between poverty and ill health—wealthier countries and wealthier individuals enjoy better health as measured by a variety of indicators such as life expectancy or incidence of waterborne diseases. Many researchers have had the same expectation about AIDS, which has often been described as a “disease of poverty” .
The economic impacts of AIDS are proportionately greater for poor households, and AIDS can be expected to increase both poverty and income inequality. At the same time, AIDS has a significant impact on the aggregate economy of high-prevalence countries.
Understanding both upstream and downstream interactions between AIDS and poverty is critical to understanding local and global epidemiological trends and patterns. Such an understanding is, in turn, vital to the development and implementation of effective strategies to prevent and treat HIV.
AIDS, it has been said, is exceptional  in terms of its threat to humanity, and its complexity. The relationship between AIDS and poverty is just one example of that complexity, having more to do with inequality than poverty per se.