PIP: This paper explores the socioeconomic obstacles to HIV prevention and treatment in developing countries. The opening sections explain the historical origins of structural adjustment programs and their characteristics. Structural adjustment programs undermine the social fabric of many developing countries, and potentially promote behaviors which place people at increased risk of HIV infection. The authors discuss the declining sustainability of the rural subsistence economy, development of a transportation infrastructure, migration and urbanization, and reductions in spending on health and social services. Social and economic interventions are needed to stem the spread of HIV and care for those who are already infected. While a substantial amount of biomedical research has been conducted, socioeconomic aspects of the AIDS epidemic have often been ignored. For HIV transmission in developing countries to be substantially reduced, economic policies which may have promoted the spread of disease must be modified. An alternative development strategy consists of satisfying people's basic human needs, shifting from an export-driven economy to diversified agricultural production in the interest of securing regional self-sufficiency, supporting marginal producers and subsistence farmers, and placing greater emphasis upon human resource development in developing countries. Moreover, the IMF and World Bank need to change their policy to one which is truly about cooperative development, while the charters of the IMF and World Bank need to be altered to permit the cancellation or rescheduling of debt. These institutions should also play a leading role in the restructuring of debt owed to private lenders.