Q: How did the worldwide trend of devolution affect municipal finance?
A: Outside of the former Soviet Union and Eastern Europe, municipal finance was not significantly affected by devolution, though there has been a tendency for decentralization. Central governments hold the purse-strings and almost all local governments operate under legislation engendered by the national, or - in federal systems - state, governments. Local governments rarely have separate constitutional authority, although there are varying degrees of local autonomy.
In the former Soviet Empire, changes of systems and of attitudes were much more dramatic. Local government units, unlike under the former Soviet system, are not branches of the general government. They are separate corporate bodies, or legal persons. But in Russia, and in other former socialist countries, they have often been granted "de jure" (legal) independence but not full "de facto" (practical) autonomy.
There seems to be an unwillingness to accept that the two systems are intended to operate quite differently. What is good for a central government is not necessarily equally good for a local government unit. For example, the main purpose of local government is to provide public services, with only enough authority to perform them effectively. It is almost always the responsibility of a central or state government to enact and enforce the criminal and civil law. Local by-laws or ordinances are usually concerned only with minor matters and are subject to an enabling legislation. Moreover, they may prove to be "ultra vires" (beyond their powers) and, therefore, unconstitutional, or at least unenforceable.
It may be appropriate, under certain circumstances, for a central government to run budgetary deficits, whether caused by current or capital transactions. In local government units, there is almost always a necessity to distinguish between such transactions. Moreover, in most countries, local government units are required by law to have balanced budgets, without resort to borrowing to cover current deficits.
A corporate body (legal person), whether a private or a public sector entity, has a separate legal identity from the central government and from the members, shareholders, or electorate who own and manage it. It has its own corporate name. Typically, its formal decisions are by resolution of its managing body (board or council). Written documents are authenticated by its common seal. It may contract, sue and be sued in its own name. Indeed, unless specifically prevented by law, it may even sue the central government! It may also have legal relationships with its own individual members or with its staff. It is often said to have perpetual succession, meaning that it lives on, even though the individual members may die, resign or otherwise cease their membership.
While a corporation owes its existence to legislation, a local government unit is established, typically, under something like a "Local Government Organic Law". Corporate status differs fundamentally from that of (say) government departments in a system of de-concentration. Permanent closure or abolition of a municipal council, or indeed any change in its powers and duties, would almost always require formal legal action, typically national parliamentary legislation.
A local government unit makes its own policy decisions, some of which, especially the financial ones, often require approval by a central government authority. Still, the central government rarely runs, or manages, a local government unit on a daily basis. The relationship is at arms length and not hands on. A local government unit usually is empowered to own land and real estate. Sometimes, public assets - such as with roads or drainage systems - are deemed to be "vested in" the local authority because they cannot be owned in the same way as buildings are.
Q: Local authorities issue bonds, partake in joint ventures, lend to SME's - in short, encroach on turf previously exclusively occupied by banks, the capital markets, and business. Is this a good or a bad thing?
A: Local governments are established to provide services and perform activities required or allowed by law! Normally, they won't seek or be permitted to engage in commercial activities, best left to the private sector. However, there have always been natural monopolies (such as water supply), coping with negative economic externalities (such as sewerage and solid waste management), the provision of whole or partial public goods (such as street lighting, or roads) and merit goods (such as education, health, and welfare), and services that the community, for economic or social reasons, seeks to subsidize (such as urban transport). Left to the private marketplace, these services would be absent, or under-supplied, or over-charged for.
Such services are wholly or partially financed by local taxation, either imposed by local governments, or by central (or state) taxation, through a grant or revenue-sharing system. What has changed in recent years is that local governments have been encouraged and empowered to outsource these services to the private sector, or to "public-private" partnerships.
Charges for services, and revenues from taxation cover current operating expenditures with a small operating surplus used to partly fund capital expenditure or to service long, or medium term debt, such as bond issues secured against future revenues. Commercial banks, because of their tendency to lend only for relatively short periods of time, usually have a relatively minor role in such funding, except perhaps as fiscal agents or bond issue managers.
Other funding is obtained via direct - and dependence-forming - capital grants from the central or state government. Alternatively, the central government can establish a quasi-autonomous local government loans authority, which it may wholly or partially fund. The authority may also seek to raise additional funds from commercial sources and make loans on reasonable terms to the local governments.
Third, the central government may lend directly to local governments, or guarantee their borrowing. Finally, local governments are left to their own devices to raise loans as and when they can, on whatever terms are available. This usually leaves them in a precarious position, because the market for this kind of long and medium term credit is thin and costly.
Commercial banks make short term loans to local governments to cover temporary shortages of working capital. If not properly controlled, such short-term loans are rolled over and accumulate unsustainably. That is what happed in New York City, in the seventies.
Q: In the age of the Internet and the car, isn't the added layer of municipal bureaucracy superfluous or even counterproductive? Can't the center - at least in smallish countries - administer things at least as well?
A: I am quite sure that they can. There are many glaring examples of mismatches of sizes, shapes and responsibilities of local government units. For example, New York, Moscow and Bombay are each single local government units. Yet, they each have much bigger populations than many countries, such as New Zealand, the republics of former Yugoslavia, and the Baltic states.
On the other hand, the Greater Washington Metropolitan Area comprises a federal district, four counties and several small cities. The local government systems are under the jurisdictions of two states and the federal government. Each of the two states has a completely different traditions and systems of local governance, emanating from pre-independence times. Accordingly, the local government systems north and east of the Potomac River (which flows through the Washington area) are substantially different from those to the south and west. Finally, the Boston area, a cradle of U.S. democracy, is governed by a conglomerate of over 40 local government jurisdictions. Even its most famous college, Harvard, is in Cambridge and not in Boston itself. Many of the jurisdictions are so small (Boston is not very big by U.S. standards) that common services are run by agencies of the State of Massachusetts.
The problem of centralizing financial records would, indeed, be relatively simple to solve. If credit card companies can maintain linkages world-wide, there is no practical reason why local government accounts for (say) a city in Macedonia could not be kept in China. The issue here is quite different. It revolves around democracy, tradition, living in community, service delivery at a local level, civil society, and the common wealth. It really has very little to do with accountancy, which is just one tool of management, albeit an important one.
Afghanistan, Economy of
I. The Poppy Fields
Conspiracy theorists in the Balkan have long speculated on the true nature of the Albanian uprising in Macedonia. According to them, Afghanistan was about to flood Europe with cheap opium through the traditional Balkan routes. The KLA - denounced by the State Department as late as 1998 as a drug trafficking organization - was, in the current insurrection, in its new guise as the NLA, simply establishing a lawless beachhead in Macedonia, went the rumours. The Taliban were known to stock c. 3000 tonnes of raw opium. The Afghanis - Arab fighters against the Soviet occupation of Afghanistan - another 2000 tonnes (their fee for providing military and security services to the Taliban). Even at the current, depressed, prices, this would fetch well over 2 billion US dollars in next door Pakistan. It also represents 5 years of total European consumption and a (current) street level value in excess of 100 billion US dollars. The Taliban intends to offload this quantity in the next few months and to convert it to weapons. Destabilizing the societies of the West is another welcome side effect.
It is ironic that the Taliban collaboration with the United Nations Office for Drug Control and Crime Prevention (UNODCCP) culminated this year in the virtual eradication of all opium poppies in Afghanistan. Only 18 months ago, Afghan opium production (c. 4600 tonnes a year) accounted for 70% of world consumption (in the form of heroin). The shift (partly forced on the Taliban by an unusual climate) from poppies to cereals (that started in 1997) was thus completed successfully.
II. Agriculture
Afghanistan is not a monolithic entity. It is a mountainous and desert territory (c. 251,000 sq. miles in size, less than 10% of it cultivated). Administratively and politically, it is reminiscent of Somalia. The Taliban government - now recognized only by Pakistan - rules the majority of the country as a series of tribal fiefdoms. The country - ruined by a decade of warfare between majority Pushtuns and minority Tajiks and Uzbeks in the north - lacks all institutions, or infrastructure. In an economy of subsistence agriculture and trading, millions (up to one third of a population of 27 million) have been internally displaced or rendered refugees. One third of all farms have been vacated. Close to 70% of all villages are demolished. Unemployment - in a mostly unskilled workforce of 11 million - may well exceed 50%. Poverty is rampant, food scarce, population growth unsustainable. The traditional social safety net - the family - has unraveled, leading to widespread and recurrent famine and malnutrition. The mainstays of grazing and cattle herding have been hampered by mines and deforestation.
The Taliban regime has been good to the economy. It restored the semblance of law and order. Agricultural production recovered to pre-Soviet invasion (1978) levels. Friendly Pakistan provided 80% of the shortfall in grain (international aid agencies provided the rest). The number of heads of livestock - the only form of savings in devastated Afghanistan - increased. Many refugees came back.
Urban workers - mostly rural labourers displaced by war - fared worse, though. As industries and services vanished and army recruitment stabilized with the Taliban's victories, salaries decreased by up to 40% while inflation picked up (to an annual average of 20-25%, as reflected in the devaluation of the currency and in the price of bread). More than 50% of the average $1 a day wage of the casual, unskilled, worker, are spent on bread alone!
But this discrepancy between a recovering agricultural sector and the dilapidated and depleted cities led to reverse migration back to the villages. In the long term it was a healthy trend.
Paradoxically, the collapse of the central state led to the emergence of a thriving and vibrant private sector engaged in both legal and criminal activities. Foreign exchange dealing is conducted in thousands of small, privately owned, exchange offices. Rich Afghani traders have invested heavily in small scale and home industries (mainly in textiles and agri-business).
III. Trade
In some respects, Afghanistan is an extension of Pakistan economically and, until recently, ideologically. Food prices in Afghanistan, for instance - the only reliable indicator of inflation - closely follow Pakistan's. The Afghan currency (there are two - one issued by the Taliban and another issued by the deposed government in Faizabad) is closely linked to Pakistan's currency, though unofficially so. The regions closest to Pakistan (Herat, Jalalabad, Kandahar) - where cross border trading, drug trafficking, weapons smuggling, illegal immigration (to Western Europe), and white slavery are brisk - are far more prosperous than the northern, war-torn, ones (Badakhshan, Bamyan). The Taliban uses economic sanctions in its on-going war against the Northern Alliance. In 1998-9, it has blockaded the populous provinces of Parwan and Kapisa.
Another increasingly important trade partner is Turkmenistan. It supplies Afghanistan with petrol, diesel, LNG, and jet fuel (thus reducing Afghani dependence on hostile Iranian supplies). Uzbekistan and Tajikistan, its two other neighbours, are considered by the Taliban to be enemies. This enmity results in much higher costs of transportation which price out many Afghan products.
With Pakistan, Afghanistan has an agreement (the Afghan Transit Trade) which provides the latter with access to the sea. Afghanistan imports consumer goods and durables through this duty free corridor (and promptly re-exports them illegally to Pakistan). Pakistani authorities periodically react by unilaterally dropping duty free items off the ATT list. The Afghans proceed to import the banned items (many of them manufactured in Pakistan's archrival, India) via the Gulf states, Russia, Ukraine (another important drug route) and into Pakistan.
IV. The Future
The current conflict can be a blessing in disguise. Western aid and investment can help resuscitate the Soviet era mining (Copper, Zinc) operations and finally tap Afghanistan's vast reserves of oil and natural gas. With a GDP per capita of less than $800, there is room for massive growth. Yet, such bright prospects are dimmed by inter-ethnic rivalry, a moribund social system, decades of war and natural disaster (such as the draught in 1998-9), and intense meddling and manipulation by near and far. One thing is certain: opium production is likely to increase dramatically. And Western users will be treated to ever cheaper heroin and Hasish.
Agent-Principal Problem
In the catechism of capitalism, shares represent the part-ownership of an economic enterprise, usually a firm. The value of shares is determined by the replacement value of the assets of the firm, including intangibles such as goodwill. The price of the share is determined by transactions among arm's length buyers and sellers in an efficient and liquid market. The price reflects expectations regarding the future value of the firm and the stock's future stream of income - i.e., dividends.
Alas, none of these oft-recited dogmas bears any resemblance to reality. Shares rarely represent ownership. The float - the number of shares available to the public - is frequently marginal. Shareholders meet once a year to vent and disperse. Boards of directors are appointed by management - as are auditors. Shareholders are not represented in any decision making process - small or big.
The dismal truth is that shares reify the expectation to find future buyers at a higher price and thus incur capital gains. In the Ponzi scheme known as the stock exchange, this expectation is proportional to liquidity - new suckers - and volatility. Thus, the price of any given stock reflects merely the consensus as to how easy it would be to offload one's holdings and at what price.
Another myth has to do with the role of managers. They are supposed to generate higher returns to shareholders by increasing the value of the firm's assets and, therefore, of the firm. If they fail to do so, goes the moral tale, they are booted out mercilessly. This is one manifestation of the "Principal-Agent Problem". It is defined thus by the Oxford Dictionary of Economics:
"The problem of how a person A can motivate person B to act for A's benefit rather than following (his) self-interest."
The obvious answer is that A can never motivate B not to follow B's self-interest - never mind what the incentives are. That economists pretend otherwise - in "optimal contracting theory" - just serves to demonstrate how divorced economics is from human psychology and, thus, from reality.
Managers will always rob blind the companies they run. They will always manipulate boards to collude in their shenanigans. They will always bribe auditors to bend the rules. In other words, they will always act in their self-interest. In their defense, they can say that the damage from such actions to each shareholder is minuscule while the benefits to the manager are enormous. In other words, this is the rational, self-interested, thing to do.
But why do shareholders cooperate with such corporate brigandage? In an important Chicago Law Review article whose preprint was posted to the Web a few weeks ago - titled "Managerial Power and Rent Extraction in the Design of Executive Compensation" - the authors demonstrate how the typical stock option granted to managers as part of their remuneration rewards mediocrity rather than encourages excellence.
But everything falls into place if we realize that shareholders and managers are allied against the firm - not pitted against each other. The paramount interest of both shareholders and managers is to increase the value of the stock - regardless of the true value of the firm. Both are concerned with the performance of the share - rather than the performance of the firm. Both are preoccupied with boosting the share's price - rather than the company's business.
Hence the inflationary executive pay packets. Shareholders hire stock manipulators - euphemistically known as "managers" - to generate expectations regarding the future prices of their shares. These snake oil salesmen and snake charmers - the corporate executives - are allowed by shareholders to loot the company providing they generate consistent capital gains to their masters by provoking persistent interest and excitement around the business. Shareholders, in other words, do not behave as owners of the firm - they behave as free-riders.
The Principal-Agent Problem arises in other social interactions and is equally misunderstood there. Consider taxpayers and their government. Contrary to conservative lore, the former want the government to tax them providing they share in the spoils. They tolerate corruption in high places, cronyism, nepotism, inaptitude and worse - on condition that the government and the legislature redistribute the wealth they confiscate. Such redistribution often comes in the form of pork barrel projects and benefits to the middle-class.
This is why the tax burden and the government's share of GDP have been soaring inexorably with the consent of the citizenry. People adore government spending precisely because it is inefficient and distorts the proper allocation of economic resources. The vast majority of people are rent-seekers. Witness the mass demonstrations that erupt whenever governments try to slash expenditures, privatize, and eliminate their gaping deficits. This is one reason the IMF with its austerity measures is universally unpopular.
Employers and employees, producers and consumers - these are all instances of the Principal-Agent Problem. Economists would do well to discard their models and go back to basics. They could start by asking:
Why do shareholders acquiesce with executive malfeasance as long as share prices are rising?
Why do citizens protest against a smaller government - even though it means lower taxes?
Could it mean that the interests of shareholders and managers are identical? Does it imply that people prefer tax-and-spend governments and pork barrel politics to the Thatcherite alternative?
Nothing happens by accident or by coercion. Shareholders aided and abetted the current crop of corporate executives enthusiastically. They knew well what was happening. They may not have been aware of the exact nature and extent of the rot - but they witnessed approvingly the public relations antics, insider trading, stock option resetting , unwinding, and unloading, share price manipulation, opaque transactions, and outlandish pay packages. Investors remained mum throughout the corruption of corporate America. It is time for the hangover.
AIDS
The region which brought you the Black Death, communism and all-pervasive kleptocracy now presents: AIDS. The process of enlargement to the east may, unwittingly, open the European Union's doors to the two scourges of inordinately brutal organized crime and exceptionally lethal disease. As Newsweek noted, the threat is greater and nearer than any hysterically conjured act of terrorism.
The effective measure of quarantining the HIV-positive inhabitants of the blighted region to prevent a calamity of medieval proportions is proscribed by the latest vintage of politically correct liberalism. The West can only help them improve detection and treatment. But this is a tall order.
East European medicine harbors fantastic pretensions to west European standards of quality and service. But it is encumbered with African financing, German bureaucracy and Vietnamese infrastructure. Since the implosion of communism in 1989, deteriorating incomes, widespread unemployment and social disintegration plunged people into abject poverty, making it impossible to maintain a healthy lifestyle.
A report published in September by the European regional office of the World Health Organization (WHO) pegs at 46 the percentage of the general population in the countries of the former communist bloc living on less than $4 a day - close to 170 million people. Crumbling and desperately underfunded healthcare systems, ridden by corruption and cronyism, ceased to provide even the appearance of rudimentary health services.
The number of women who die at - ever rarer - childbirth skyrocketed. Transition has trimmed Russian life expectancy by well over a decade to 59, lower than in India. People lead brutish and nasty lives only to expire in their prime, often inebriated. In the republics of former Yugoslavia, respiratory and digestive tract diseases run amok. Stress and pollution conspire to reap a grim harvest throughout the wastelands of eastern Europe. The rate of Tuberculosis in Romania exceeds that of sub-Saharan Africa.
UNAIDS and WHO have just published their AIDS Epidemic Update. It states unequivocally: "In Eastern Europe and Central Asia, the number of people living with Human Immunodeficiency Virus - HIV - in 2002 stood at 1.2 million. HIV/AIDS is expanding rapidly in the Baltic States, the Russian Federation and several Central Asian republics."
The figures are grossly understated - and distorting. The epidemic in eastern Europe and central Asia - virtually on the European Union's doorstep - is accelerating and its growth rate has surpassed sub-Saharan Africa's. One fifth of all people in this region infected by HIV contracted the virus in the preceding 12 months. UNAIDS says: "The unfortunate distinction of having the world’s fastest-growing HIV/AIDS epidemic still belongs to Eastern Europe and Central Asia."
In the past eight years, AIDS has been suddenly "discovered" in 30 large Russian cities and in 86 of its 89 regions. Four fifth of all infections in the Commonwealth of Independent States - the debris left by the collapse of the USSR - are among people younger than 29. By July this year, new HIV cases surged to 200,000 - up from 11,000 in December 1998.
In St. Petersburg, their numbers multiplied a staggering 250-fold since 1996 to 10,000 new instances diagnosed in 2001. Most of these cases are attributed to intravenous drug use. But, according to Radio Free Europe/Radio Liberty, 400 infected women gave birth in a single hospital in St. Petersburg in the first nine months of 2002 - compared to 149 throughout last year. About one third of the neonates test HIV-positive within 24 months. The disease has broken loose.
How misleading even these dire data are is revealed by an in-depth study of a single city in Russia, Togliatti. Fully 56 percent of all drug users proved to be HIV-positive, most of them infected in the last 2 years. Three quarters of them were unaware of their predicament. One quarter of all prostitutes did not require their customers to use condoms. Two fifths of all "female sex workers" then proceeded to have unsafe intercourse with their mates, husbands, or partners. Studies conducted in Donetsk, Moscow and St. Petersburg found that one seventh of all prostitutes are already infected.
An evidently shocked compiler of the results states: "The study lends further credence to concerns that the HIV/AIDS epidemic in Russian cities could be considerably more severe than the already-high official statistics indicate." The region's governments claim that 1 percent of the population of countries in transition - still a hefty 4 million people - use drugs. But this, too, is a wild underestimate. UNAIDS itself cites a study that concluded that "among Moscow secondary-school students ... 4% had injected drugs".
Quoted in Pravda.ru, The Director of the Federal Scientific Center for AIDS at Russia's Ministry of Health, Vadim Pokrovsky, warns that Russia is likely to follow the "African model" with up to an 80 percent infection rate in some parts. Kaliningrad, with a 4 percent prevalence of the syndrome, he muses, can serve as a blueprint for the short-term development of the AIDS epidemic in Russia.
Or, take Uzbekistan. New infections registered in the first six months of 2002 surpassed the entire caseload of the previous decade. Following the war in Afghanistan, heroin routes have shifted to central Asia, spreading its abuse among the destitute and despondent populations of Azerbaijan, Kazakhstan, Georgia, Kyrgyzstan, Tajikistan and Uzbekistan. In many of these countries and, to some extent, in Russia and Ukraine, some grades of heroine are cheaper than vodka.
Ominously, reports the European enter for the Epidemiological Monitoring of AIDS, as HIV cases among drug users decline, they increase exponentially among heterosexuals. This, for instance, is the case in Belarus and Ukraine. The prevalence of HIV among all Ukrainians is 1 percent.
Even relative prosperity and good governance can no longer stem the tide. Estonia's infection rate is 50 percent higher than Russia's, even if the AIDS cesspool that is the exclave of Kaliningrad is included in the statistics. Latvia is not far behind. One of every seven prisoners in Lithuania has fallen prey to the virus. All three countries will accede to the European Union in 2004. Pursuant to an agreement signed recently between Russia and the EU, Kaliningrad's denizens will travel to all European destinations unencumbered by a visa regime.
Very little is done to confront the looming plague. One third of young women in Azerbaijan and Uzbekistan never heard of AIDS. Over-crowded prisons provide no clean needles or condoms to their inmates. There are no early warning "sentinel" programs anywhere. Needle exchanges are unheard of. UNICEF warns, in its report titled "Social Monitor 2002", that HIV/AIDS imperils both future generations and the social order.
The political class is unmoved. President Vladimir Putin never as much as mentions AIDS in his litany of speeches. Even Macedonia's western-minded and western-propped president, Boris Trajkovski, dealt with the subject for the first time only yesterday. Belarus did not bother to apply to the United Nation's Global Fund to Fight AIDS, Tuberculosis, and Malaria or to draw approved resources from the World Bank's anti-TB/HIV/AIDS project.
In many backward, tribal countries - especially in the Balkan and in central Asia - the subjects of procreation, let alone contraception, are taboo. Vehicles belonging to Medecins du Monde, a French NGO running a pioneer needle exchange program in Russia, were torched. The Orthodox Church has strongly objected to cinema ads promoting safer sex. Sexual education is rare.
Even when education is on offer - like last year's media campaign in Ukraine - it rarely mitigates or alters high-risk conduct. According to Radio Free Europe/Radio Liberty, the St. Petersburg AIDS Center carried out a survey of 2000 people who came to be tested there and were consequently exposed to AIDS prevention training. "Neither the men nor the women had changed their high-risk behavior", is the unsettling conclusion.
Ignorance is compounded by a dismal level personal hygiene, not the least due to chronically malfunctioning water, sanitation and electricity grids and to the prohibitive costs of cleansing agents and medicines. Sexually transmitted diseases - the gateways to the virus - are rampant. Close to half a million new cases of syphilis are diagnosed annually only in Russia.
The first step in confronting the epidemic is proper diagnosis and acknowledgement of the magnitude of the problem. Macedonia, with 2 million citizens, implausibly claims to harbor only 18 carriers and 5 AIDS patients. A national strategy to confront the syndrome is not due until June next year. Though AIDS medication is theoretically provided free of charge to all patients, the country's health insurance fund, looted by its management, is unable to afford to import them.
In a year of buoyant tax revenues, the Russian government reduced spending on AIDS-related issues from $6 million to $5 million. By comparison, the U.S. Agency for International Development (USAID) alone allocated $4 million to Russia's HIV/AIDS activities last year. Another $1.5 were given to Ukraine. Russia blocked last year a $150 million World Bank loan for the treatment of tuberculosis and AIDS.
Money is a cardinal issue, though. Christof Ruehl, the World Bank's chief economist in Russia and Murray Feshbach, a senior scholar at the Woodrow Wilson International Center for Scholars in Washington, put the number of infected people in the Russian Federation at 1-1.2 million. Even this figure - five times the official guesstimate - may be irrationally exuberant. A report by the US National Intelligence Council forecasts 5-8 million HIV-positives in Russia by the end of the decade. Already one third of conscripts are deemed unfit for service due to HIV and hepatitis.
Medicines are scarce. Only 100 of St. Petersburg's 17,000 registered HIV carriers receive retroviral care of any kind. Most of them will die if not given access to free treatment. Yet, even a locally manufactured, generic version, of an annual dose of the least potent antiretroviral cocktail would cost hundreds of dollars - about half a year's wages. At market prices, free medicines for all AIDS sufferers in this vast country would amount to as much as four fifths of the entire federal budget, says Ruehl.
Some pharmaceutical multinationals - spearheaded by Merck - have offered the more impoverished countries of the region, such as Romania, AIDS prescriptions at 10 percent of the retail price in the United States. But this is still an unaffordable $1100 per year per patient. To this should be added the cost of repeated laboratory tests and antibiotics - c. $10,000 annually, according to the New York Times. The average monthly salary in Romania is $100, in Macedonia $160, in Ukraine $60. It is cheaper to die than to be treated for AIDS.
Indeed, society would rather let the tainted expire. People diagnosed with AIDS in eastern Europe are superstitiously shunned, sacked from their jobs and mistreated by health and law enforcement authorities. Municipal bureaucracies scuttle even the little initiative shown by reluctant governments. These self-defeating attitudes have changed only in central Europe, notably in Poland where an outbreak of AIDS was contained successfully.
And, thus, the bleak picture is unlikely to improve soon. UNAIDS, UNICEF and WHO publish country-specific "Epidemiological Factsheets on HIV/AIDS and Sexually Transmitted Infections". The latest edition, released this year, is disheartening. Under-reporting, shoddy, intermittent testing, increasing transmission through heterosexual contact, a rising number of infected children. This is part of the dowry east Europe brings to its long-delayed marriage with a commitment-phobic European Union.
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