The Impact of HIV/AIDS on Livelihoods, Poverty and the Economy of Malawi (review)

This is an important, carefully crafted book, offering a set of distinctive perspectives and provocative analytical insights about the impact of HIV/AIDS on socioeconomic development, both in Malawi and in other sub-Saharan African countries equally ravaged by the pandemic. The authors marshal and critically survey the data derived from a wealth of fresh studies; to that data set they apply an original analysis and add their own anecdotal reporting collected from interviews with people from government, academia, the donor community, the private sector, and NGOs in Malawi. Assessing how HIV/AIDS affects different sectors at a variety of levels—individual, household, community, and nation—the book underscores that the AIDS epidemic remains the leading threat to development in sub-Saharan Africa and in Malawi in particular, which now is witnessing significant reversals in socioeconomic development.

It also points to growing evidence of the ways in which social environments shape the dynamics of disease transmission and its evolution, and of how economic, political, social, and cultural factors contribute to and are affected by both the epidemic and the responses to it. The authors acknowledge the inconclusive nature of the findings, mainly attributable to lack of sufficient and reliable data from which comprehensive analyses could have been made to capture more fully the impact of HIV/AIDS. Nonetheless, it is undeniable that security and livelihood have been affected, both through the effects of premature illness and deaths of adults who provide the bulk of family labor power, and by the rupture of customary intergenerational knowledge transfers.

Despite being persuasive and witty, the book is not without blemishes, especially as it relates to further research, policy development, and economic development at large. The authors identify one channel in particular through which HIV/AIDS affects economic growth in Malawi: by depressing private savings the epidemic reduces investment, which in turn reduces economic growth. Indeed, there is a growing consensus in the development literature that most sub-Saharan African countries are caught in a poverty trap partly because they lack sufficient savings that could pull them out of lower rates of growth. However, the magnitude of this effect is unclear; even absent the epidemic, it is questionable that the meager savings in Malawi and elsewhere in Africa would have countered that trend and contributed to growth.

In addition, Arrehag and her colleagues in most cases emphasize the impact of HIV/AIDS on socioeconomic development, while ignoring the effects of policy measures implemented under auspices of the World Bank and IMF-sponsored Structural Adjustment Programs (SAPs). For instance, they point to the failure of farmers to purchase farm inputs because of the decline in their income due to the epidemic. But it can also be argued that SAPs led to the complete removal of input subsidies in the 1990s, the same period during which the effects of HIV/AIDS became evident. Empirical studies assessing the effects of SAPs have indicated that the removal of production subsidies placed farm inputs out of reach for most peasants; and even for those who managed to purchase farm inputs, the cost of production remained high relative to commodity prices, making farm production unprofitable. This could also explain the reduction of the area under cultivation for most crops and extended fallow, as most peasants sought other means of generating income, such as petty commodity production. Therefore, attributing changes within the farming systems in sub-Saharan Africa only to the HIV/AIDS pandemic, without mentioning the impact of SAPs, may result in missing the broad array of factors that contribute to change, and hence to insufficient and inappropriate policy development.

It is incontestable that the book is insightful, practical, and well written, although most of the findings presented are inconclusive. The authors could have selected only a few problems and analyzed them in more comprehensive fashion to come...