There are presently 42 million people living with HIV/AIDS today, nearly 30 million of whom live in Sub-Saharan Africa. But HIV/AIDS is not only an African epidemic.  It has reached almost every country; more than 6 million infected in South Asia, 1  million in East Asia, 1 million in Eastern Europe/Central Asia and upwards of 1.5 million in Latin America (UNAIDS). HIV/AIDS is now spreading most rapidly in the Caribbean, Eastern Europe and Central Asia.  HIV spreads quickly; in many countries rates have risen tenfold in just a few years.

Cities and towns present unique challenges and opportunities in the fight against HIV/AIDS. By 2015 (only twelve years from now) fifty percent of the population in the developing world will be living in cities; in 2000 nearly two million of the world’s three million urban residents lived in the developing world (UN Population Division). Cities are often the driving force behind economies as well as disease, due to high population density, transportation hubs and the existence of large groups of vulnerable persons (e.g., sex workers, unemployed youth, drug users). HIV/AIDS has the potential to undermine the considerable investments by cities and towns, national governments, donors and civil society organizations in the core areas of municipal management, municipal finance, local service delivery (particularly to the poor) and local economic development.

As more people are infected with HIV/AIDS, a city will see decreases in labor productivity, increased demand for services, lower capacity of users to pay for services, increased household vulnerability and increased numbers of absolute poor (e.g., orphans, People Living with HIV/AIDS).  The climate for private investment will deteriorate and local government itself will suffer the absenteeism and productivity losses that result from increasing prevalence.

A study in Zambia shows that 2/3 of urban households that lost their main breadwinner to AIDS experienced a loss of income of 80%. The same study found that 61% of these households had moved to cheaper housing, 39% lost piped water, and 21% of girls and 17% of boys dropped out of school. (UNAIDS)

The responsibility for dealing with these issues of urban poverty, housing, municipal services, and education rests largely with local governments. Good due diligence, risk analysis and risk mitigation should underpin investments in urban development programs.

Yet, to what extent are local governments able, willing and encouraged to address HIV/AIDS directly? Many local government authorities have already started implementing HIV/AIDS programs and policies, with some success (e.g., Msunduzi Municipality in South Africa. Yet, many more do not have the resources or the support to address the prevention, management and care services that their populations need and/or will need.