Abstract – Relative response: Ranking country responses to HIV and AIDS

Chris Desmond, Evan Lieberman, Anita Alban, and Anna-Mia Ekström

Health and Human Rights 10/2

Published December 2008


The aim of this article is to support efforts to hold governments accountable for their commitments to respond to HIV and AIDS. It describes a new approach to ranking countries’ responses in order to facilitate cross-country comparisons. The method uses the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) Declaration of Commitment as its point of departure and was designed to rank countries in terms of their efforts to fight HIV and AIDS. Three indicators of the country response were analyzed: 1) prevention of mother-to-child transmission (PMTCT) coverage; 2) antiretroviral (ARV) coverage; and 3) the ratio of orphans to non-orphans attending school. An assessment of this nature must acknowledge the unique situation of each country, depending on its infrastructure and access to resources. To account for these differences, a regression analysis with contextual control variables was carried out to identify the variation resulting from controllable factors. It is this variation which is used to examine countries’ relative response to HIV as it considers what was actually achieved relative to what was expected given the context. The results highlight the efforts of not only some well-reputed, strong actors but also some unexpected front-runners. The results also point to a group of countries which are lagging behind in all regards. Comparisons between the three indicators show great variations in the focus of countries’ efforts. Rating countries’ relative response to HIV highlights countries that do well in spite of difficult circumstances. The article argues that these “relative overachievers” should be examined more closely so that lessons may be learnt from their efforts. The rating also draws attention to countries where the response is comparatively weak, and where governments, as lead actors in the AIDS partnership, bear the greatest responsibility.