Northeastern University School of Law, Boston, MA 02124, USA.
Int J Health Serv. 2010;40(2):347-63. doi: 10.2190/HS.40.2.p.
Expansion of funding for HIV/AIDS, especially treatment, is under attack over concerns about cost effectiveness and financial constraints. The International Monetary Fund is deeply implicated in the history of the AIDS pandemic, the underlying weakness of health systems, and the ideology of constrained resources that underlies most attacks on AIDS funding. The IMF imposed structural violence on developing countries in the 1980s and 1990s through neoliberal and macroeconomic reforms that intensified individual and communal vulnerability to infection and dismantled already weak health systems. This same macroeconomic fundamentalism has recently been repackaged and renamed. IMF fundamentalist policies continue to prioritize low inflation, constricted government spending, robust foreign currency reserves, and prompt repayment of debt at the expense of investments in health and more expansionary, pro-growth and job-creation policies. Several recent surveys have concluded that the IMF reluctantly relaxed overly restrictive policy prescriptions in response to the global economic crisis, but this relaxation was temporary at best and only extended to countries previously acceding to IMF orthodoxy. AIDS activists are campaigning for billions of dollars to fulfill the promise of universal access. If IMF pressures persist, developing countries will continue to undermine the additionality of donor health financing by substituting donor for domestic financing, refusing to invest in recurrent costs for medicines and health workers, and neglecting needed investments in health infrastructure and health system strengthening.
对艾滋病（AIDS）资金投入，尤其是治疗资金投入的扩大，正面临着人们对成本效益和财政限制的担忧的冲击。国际货币基金组织（IMF）在艾滋病大流行的历史、卫生系统的潜在弱点以及资源有限观念中扮演着重要角色，而这种观念是对艾滋病资金投入的大多数攻击的根源。上世纪 80 年代和 90 年代，国际货币基金组织通过新自由主义和宏观经济改革，对发展中国家实施了结构性暴力，这些改革加剧了个人和社区感染的脆弱性，破坏了已经脆弱的卫生系统。这种同样的宏观经济原教旨主义最近被重新包装并重新命名。国际货币基金组织的原教旨主义政策继续优先考虑低通胀、限制政府支出、强劲的外汇储备以及迅速偿还债务，而牺牲了对卫生的投资以及更具扩张性、促进增长和创造就业的政策。最近的几项调查得出的结论是，国际货币基金组织不情愿地放宽了过于严格的政策规定，以应对全球经济危机，但这种放宽充其量只是暂时的，而且只扩展到那些以前一直遵循国际货币基金组织正统观念的国家。艾滋病活动家正在争取数十亿美元，以兑现普及治疗的承诺。如果国际货币基金组织的压力持续存在，发展中国家将继续通过用捐助者资金替代国内资金、拒绝为药品和卫生工作者的经常性费用投资以及忽视卫生基础设施和卫生系统加强所需投资等方式，破坏捐助者卫生筹资的额外性。
