The fiscal dimension of HIV : AIDS in Botswana South Africa Swaziland and Uganda HIV AIDS imposes enormous economic social health and human costs and will continue to do so for the foreseeable future. The challenge is particularly acute in Sub Saharan Africa home to two thirds (22.5 million) of the people living with HIV AIDS globally and where HIV AIDS has become the leading cause of premature death. But now after decades of misery and frustration with the disease there are signs of hope. HIV prevalence rates in Africa are stabilizing. This book sheds light on these concerns by analyzing the fiscal implications of HIV AIDS in Southern Africa the epicenter of the epidemic. It uses the toolbox of public finance to assess the sustainability of HIV AIDS programs. Importantly it highlights the long term nature of the fiscal commitments implied by HIV AIDS programs and explicitly discusses the link between HIV infections and the resulting commitments of fiscal resources. The analysis shows that absent adjustments to policies treatment is not sustainable. But it also shows that by accompanying treatment with prevention and making existing programs more cost effective these countries can manage both treatment and fiscal sustainability. Even in countries where HIV AIDS related spending is high or increasing (as past infections translate into an increasing demand for treatment) the fiscal space absorbed by the costs of HIV AIDS related services will decline if progress in containing and rolling back the number of new infections can be sustained. The purpose of this study is to refine the analysis of the fiscal burden of HIV AIDS on national governments and assess the fiscal risks associated with scaling up national HIV AIDS responses. The study complements and contributes to the agenda on identifying and creating fiscal space for HIV AIDS and other development expenditures. The findings from this study and the analytical tools developed in it could help governments in defining policy objectives improving fiscal planning and conducting their dialogue with donor agencies.