HIV Foreign Assistance and Adult Mortality in Africa

Eran Bendavid, Stanford University
Charles Holmes, Office of the U.S. Global AIDS Coordinator

The effect of global health initiatives on population health is uncertain. Between 2004 and 2008, the US President’s Emergency Plan for AIDS Relief (PEPFAR) operated intensively in twelve African focus countries. We examined whether PEPFAR was associated with changes in adult mortality using data on 1,525,518 adults from 27 countries (9 focus). We compared adult mortality (annual deaths per 1,000 person-years) in focus countries to neighboring countries from 1998-2008 using difference-in-differences with fixed effects. We performed sub-national analyses in Tanzania and Rwanda. Overall, adult mortality peaked near 7.5/1,000PY in 2003. Declines in adult mortality were most prominent in the focus countries. Odds of death were lower by 19.8% among adults living in focus countries between 2004 and 2008 (4.3-32.7%, p=0.01). Within Tanzania and Rwanda, the odds of death were 12-37% lower in districts with greater programmatic activity. These findings could inform decisions about resource allocation for future development assistance programs.