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OP48 #A systematic review and theory synthesis for the impact of foreign aid on HIV/AIDS in sub-saharan africa
  1. MT Little1,
  2. B Larsen1,2,
  3. L Cluver1,3,
  4. DK Humphreys1
  1. 1Department of Social Policy and Intervention, University of Oxford, Oxford, UK
  2. 2Saïd Business School, University of Oxford, Oxford, UK
  3. 3Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa


Background Despite billions of dollars invested in the global HIV/AIDS response, the disease remains an epidemic throughout much of Sub-Saharan Africa. However, no literature has comprehensively or systematically explored the causal mechanisms between input of foreign aid and changes in HIV/AIDS outcomes. Understanding these pathways remains vital for improving the effectiveness of foreign aid programmes. This review advances this knowledge by investigating: How does foreign aid impact on HIV/AIDS outcomes in Sub-Saharan Africa? It aimed to construct a meta-theoretical framework, which facilitated identifying gaps in the evidence-base.

Methods A systematic review was conducted following PRISMA guidelines on 17 databases and 24 grey literature sources. The search strategy combined terms for foreign aid, implementation, evaluation, theory, and HIV/AIDS. Included studies had to be published after 1997 and contain theory-based and process-level discussions of how foreign aid impacts on HIV/AIDS in Sub-Saharan Africa. Studies were appraised for risk of bias in study design and theoretical rigour; high-quality studies were used to construct the initial framework and remaining studies were considered case-by-case for potential contributions to a generalisable framework. Theory synthesis was conducted using thematic analysis in order to map the pathways between aid input and changes in HIV/AIDS outcomes.

Results Of the 2423 unique articles identified, 45 records were screened at full-text for eligibility. From the 15 included studies, four themes emerged. First, there exists a clear, linear causal pathway between aid input and improved treatment coverage; however, there remain weak theoretical linkages connecting foreign aid to other HIV/AIDS outcomes. Second, no evaluation fully-captures the influence of the physical environment or the multitude of factors in the social environment acting as structural determinants of HIV/AIDS outcomes. Third, the determinants of aid allocation limit the generalisability of the framework to countries that have a baseline government capacity to address the epidemic. Fourth, there remains no evidence-base in the conceptual understanding of foreign aid’s impact on HIV/AIDS outcomes in vulnerable populations, including sex workers, the LGBTQ+ community, and children.

Conclusion The synthesis demonstrated that there is a complex pathway from foreign aid input to changes in HIV/AIDS outcomes. It also highlighted the breadth and diversity of pathways through which aid may impact on core and intermediary outcomes. Due to limited empirical analysis evaluating the system-level complexities of the topic, the framework remains reliant on a spare evidence-base. The framework provides a starting point for considering where resources should be directed to explore under-researched areas.

  • Systematic Review
  • Theory Synthesis

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