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HIV Epidemic Still Africa’s Leading Cause of Premature Death

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May 14, 2008 — The HIV/AIDS epidemic will remain for the foreseeable future an unprecedented economic, social, and human challenge to Sub-Saharan Africa. This, according to a new strategy on HIV/AIDS in Africa launched by the World Bank Group on May 14. As well, African countries must continue to champion efforts to slow and reverse the rate of new HIV infections.

According to the new report — The World Bank’s Commitment to HIV/AIDS in Africa: Our Agenda for Action, 2007–2011 — the region remains the global epicenter of the disease. For every infected African starting antiretroviral therapy (ART) for the first time, another four to six become newly infected, even though regional figures show falling prevalence in countries such as Kenya, and parts of Botswana, Côte d’Ivoire, Malawi, and Zimbabwe.1

Preventing new HIV infection is key to reversing the epidemic in Africa.

About 22.5 million Africans are HIV positive, and AIDS is the leading cause of premature death on the continent, especially among productive young people and women. As a result, some private firms in Southern Africa recruit two workers for every job in anticipation of losing staff to the disease.

How to Fight

In laying out its continuing plans to help African countries fight the epidemic, the World Bank’s new strategy says that more than 60 percent of people living with HIV in Africa are women, and that young women are six times more likely to be HIV positive than are young men. As a result of the epidemic, an estimated 11.4 million children under age 18 have lost at least one parent.

“With AIDS the largest single cause of premature death in Africa, we can’t talk about better, lasting development there without also committing to stay the course in the long-term fight against the disease,” says Elizabeth Lule, manager of the Bank’s AIDS Campaign Team for Africa (ACTAfrica), which consulted widely with African countries, people living with HIV, sister U.N. agencies, NGOs, private companies and others in devising the new strategy. 

Next Steps through 2011

The Bank has mobilized more than $1.5 billion to more than 30 countries in Sub-Saharan Africa to combat the epidemic since 2000.

With its ‘Agenda for Action’ strategy, the Bank says it is moving away from its initial ‘emergency response’ role as the world’s principal financier of HIV/AIDS programs, toward a new mission with four new strategic objectives:

  • At the global level, advising countries on how best to manage the complexity of the international agenda;
  • At the local level, helping countries develop a long-term sustainable development response to HIV/AIDS;
  • Strengthening the monitoring and evaluation capacity of countries to track the efficiency, effectiveness, and transparency of their HIV/AIDS response; and
  • Building up stronger health and fiduciary systems.

Combining Services

Amalgamating HIV/AIDS services with those for reproductive and maternal health, nutrition, and other diseases such as malaria and TB would remedy a long-standing defect in many national HIV/AIDS programs to date.

Kabutare Hospital

Anti-retroviral drugs allow this couple at Kabutare Hospital, Rwanda, to stay alive and raise their child together.

The ‘feminization’ of the epidemic and its links to sexual and reproductive health, and the frequency of co-infection with TB — including the emerging Extensively Drug-Resistant form of TB — and other opportunistic diseases, amplify the importance of providing people with integrated health services.


Specifically, the Bank would commit to: provide at least $250 million a year for HIV/AIDS initiatives, based on country demand; establish a grant incentive fund of $5 million annually to promote capacity building, analysis, and HIV/AIDS project components in key sectors such as health, education, transport, and public sector management.

“After 25 years, it is time to apply the lessons of experience and scale up what is working,” says Peter Piot, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS).“With this Agenda for Action, the World Bank reaffirms its long-term commitment to assist partner countries achieve…universal access…to HIV prevention, treatment, care, and support by integrating AIDS into their national development agendas, scaling up… responses, and strengthening national systems.”

1UNAIDS has recently updated this based on a downward revision of numbers earlier this year. The most current figure for Africa is 5 new infections for every 2 people starting ART.

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