| Background | HIV/AIDS continues to be a major development, global health and security challenge, particularly in Southern Africa. It reverses life expectancy gains, erodes productivity, decimates the workforce, consumes savings and dilutes poverty efforts, threatening realization of the Millenium Development Goals (MDGs) in Africa. HIV and AIDS statistics as of November 2007 REGION | Adults (15+) and children living with HIV | Adults (15+) and children newly infected with HIV | Adults (15 – 49) prevalence (%) | Adults (15+) and child death due to AIDS | No. of Orphans | Sub-Saharan Africa | 22.5 million | 1.7 million | 5.0 | 1.6 million | 11.4 million | World | 33.2 million | 2.5 million | 0.8 | 2.1 million | | Africa’s Burden | 68% | 68% | | 76% | |
Women especially bear a disproportionate part of the AIDS burden in Sub-Saharan Africa - the majority of people living with HIV are women (61%). A morbid “equilibrium” has been reached across Sub-Saharan Africa – the number of newly infected people nearly equals the number of people dying due to AIDS. In Southern Africa, 35% of all people are living with HIV and almost one third (32%) of all new HIV infections and AIDS deaths globally in 2007 occur in this subregion. . National adult HIV prevalence exceeded 15% in eight countries in 2005 ( Botswana, Lesotho, Mozambique, Namibia, South Africa, Swaziland, Zambia and Zimbabwe). Antiretroviral therapy (ART) has increased more than eight-fold in Africa, with over 1 million people now on ART but it is still only available to one in four patients (23%) who need it. Scale-up has been especially successful in Botswana , Kenya, Malawi, Namibia, Rwanda, South Africa, Uganda and Zambia. There is urgent need to scale up coverage and access to treatment services, and sustain treatment for those already receiving it – for every one person beginning ART; six people are newly infected with HIV!
| | Key Issues in HIV/AIDS | - Mitigation of gender inequalities and feminization of the HIV epidemic continue to be one of the most needed strategic areas of intervention. Integration of gender equality into development policy and HIV/AIDS programs at the country level is a high priority, but the lack of political will, limited capacity, restricted funding and weak institutions make integration a major challenge.
- Scaling up existing tools and methods, as well as providing innovative and effective prevention tools that incorporate a gender-perspective is a priority. More in-depth analytical work to shape decision making, provide the basis for training, and integrate gender aspects into operational research, pilot testing and service delivery would have significant benefits if tackled at the country, regional and institutional levels.
- Although financing for HIV/AIDS programs has increased to US$8.9 billion in 2007, significant funding gaps still exist. To achieve the universal access to prevention and treatment, a recent UNIADS reportidentifies $8.1 billion funding gap between resources needs and resource availability in 2007 (from 2.8 billion in 2005).
- HIV/AIDS is recognized as regional public good and a cross-border issue, requiring inter-country cooperation to track the epidemic, prevent the spread of drug resistance, and sufficiently address refugee and mobile populations, and transport corridors. The Bank has played a critical role in addressing this issue as part of regional intergration through subregional HIV/AIDS projects.
| | World Bank Regional HIV/AIDS Program | Lending: Regional HIV Portfolio | Country projects since 2001 | 42 approved, including 7 repeater projects ($267 million) | | Sub-regional projects | 5 approved (US$122 million), 1 under preparation | | Total commitments | 1.5 billion (US$256 million in FY07 alone) | | Total disbursements | 1 billion | | 2nd generation MAP Pipeline projects under preparation | Benin, Burkina Faso, Ethiopia, Eritrea, Ghana, Kenya, and Madagascar (approved); Bostwana (buy down), Malawi, Zambia and a HIV/AIDS Southern transport Corridor. |
- Recognizing the implementation bottlenecks and the development of a regional HIV/AIDS results Scorecard, eight projects were restructured to align the project development objectives to national strategy and to the Scorecard. The Scorecard is linked to the Africa region Results Monitoring System (ARMS).
- In partnership with UNAIDS, ACTafrica launched specialized Technical Support Teams (TST) to support national programs facing implementation bottlenecks. TST conducts in-depth reviews of the national AIDS program, identify existing bottlenecks and recommend pragmatic actions to improve performance. This support has been provided to Senegal, Niger and Madagascar. Burkina Faso is planned for November.
- With UNAIDS financing,AIDS Strategy and Action Planning (ASAP) support was provided to 18 countries (and two civil society organizations and one regional project). The support included review, technical support, planning, costing, and capacity development for more evidence based national programming.
- Six MAPs closed in FY07 after disbursing over $230 million collectively: Benin, Burkina Faso, Cameroon, Ethiopia, Gambia and Uganda.
- The Bank is working with other key players to identify mechanisms to address the hyper-epidemics in Southern Africa and address the regional issues fueling the epidemic, including preparation of anew project in Botswana using a buy-down from the European Union. The Bank is developing a Southern Africa Regional Transport Corridor HIV/AIDS project to address vulnerable groups along the transport corridors of Malawi-Mozambique, South Africa- Zimbabwe, and reach the epicenter of the epidemic in the hardest hit middle-income countries in the region.
- Regional project for the Horn of Africa: the US$15 million IGAD Regional HIV/AIDS Partnership Program (IRAPP) Support Project was approved in June (the first approved under the Africa Catalytic Growth Fund), became effective in September, and will be launched in December 2007 in Uganda. IRAPP is dedicated exclusively to combating HIV/AIDS among cross-border and mobile populations and IDPs in the Horn of Africa – adding value to national efforts.
- Disease Integration: The Africa region has scaled up its efforts to address TB-HIV integration in nine high-burden TB countries, and established a regional TB team covering both technical and operations areas. Detailed situation analyses of four countries have been completed, and plans finalized to conduct specialized studies in the areas of HIV/TB drug resistance and country capacity development. The Bank is also working with other partners on integration of HIV and Reproductive Health, and Maternal and Child Health programs.
- The Regional HIV/AIDS Treatment Acceleration Program (TAP) project was extendedin September in preparation for project restructuring in October 2007 to incorporate greater focus on learning lessons from country experiences and research on the benefits, risks, risk mitigation and management modalities for scaling up antiretroviral treatment in Africa.
AfricaRegion HIV/AIDS Agenda for Action 2007-2011 (AFA) The Africa Region's " HIV/AIDS Agenda for Action 2007-2011" is the culmination of a year long consultation and analytical process. The AFA positions the Bank for the next phase of the African response, given the many changes that have taken place globally in the HIV/AIDS arena since 2000. The Board will hold a Technical Discussion on the AFA in early November 2007. The strategic objectives of AFA include: - Bank sectors are increasingly incorporating HIV/AIDS components into their sectoral lending operations. As of end-FY07, 33 active projects have HIV/AIDS components worth $300 million in commitments. Over the five-year AFA period, the region will scale up mainstreaming HIV/AIDS in Agriculture, Social Development, Rural Development, Transport, Education, Mining, Urban Development and the Private Sector.
- ACTafrica will focus its future analytical and operational assistance on the key strategic challenges facing HIV responses, including a US$444,000 proposal for gender mainstreaming in HIV operations and effective capacity development of Bank staff, national AIDS commissions, and civil society in key program areas.
- Improving governance in HIV/AIDS programs. In collaboration with the Tanzania Government, WBI and GHAP, ACTafrica cosponsored a Capacity Enhancement Program in the HIV/AIDS response at the district and community levels in Tanzania in October. Assessments are planned for FY08 in select countries to examine governance issues in community responses.
- ACTafrica will host a learning event on “Targeting Vulnerable Groups in HIV/AIDS Activities in Sub-Saharan Africa” for anglophone countries in January 2008, following a similar francophone workshop held in May 2006. The objective will be to ensure sustainability by incorporating the experiences, needs and interests of anglophone countries in the design, implementation and monitoring of interventions targeting vulnerable groups such as commercial sex workers, long-distance truck drivers, refugees, women, youth, prisoners, and men who have sex with men (MSM).
Guidelines for Improved Implementation - Working with respective UN agencies and other teams, ACTafrica has developed guidelines to assist countries, donors and technical entities on key implementation areas:
- Assessments on HIV/AIDS and demobilization and reintegration of ex-combatants conducted in Angola , Burundi, Congo-Brazzaville and Rwanda on HIV/AIDS activities implemented by demobilization programs with collaboration with Banks Demobilization and Reintegration team (MDRP).
- AnHIV/AIDS Results Scorecard was developed with relevant Bank units and UNAIDS, which will apply to all ongoing and future HIV/AIDSoperations in the Region. The Scorecardwill reduce country burden on multiple reporting per the Paris Declaration recommendations; contribute to M&E harmonization at country level; and provide a better tool to report on the response to the epidemic.
- "A Synthesis of International Guidance for HIV/AIDS, Nutrition and Food Security" was developedby the World Bank, WFP, WHO, UNAIDS and bilateral experts. The Bank and its partners are assistingMozambique and the Republic of the Congo to review their national HIV, nutrition and food security programs to make them more effective.
- Analytical work resulting in the "HIV/AIDS and the Prison Community: Opportunities for Action " document will serve as a basis for a technical meeting in Mombasa in November 2007 with the World Bank, UNODC and UNAIDS.
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| | Partnerships | - The Bank is working with PEPFAR/OGAC in planning for the Implementers Meeting which reviews successes, lessons learned and challenges identified during implementation of programs supported by the three main donors (PEPFAR, Global Fund and World Bank). The first regional meeting was held in Rwanda in June 2007 and the second one is scheduled to be held in Uganda in June 2008.
- Stronger partnership has been developed with WHO in addressing TB/HIV integrated responses at the country level. With support from the Dutch Government, an assessment and capacity development program has been launched.
| | Next Steps | - ACTafrica will host several events to commemorate World AIDS Day 2007 and highlight the Region’s support to national HIV/AIDS programs.
- ACTafrica has planned key stakeholder consultations to jumpstart the five year Agenda for Action. These consultations include: (a) Private Sector Partnership in scaling up national AIDS responses in December 2007 in Mali; (b) Stakeholder consultation with global and sectoral trade unions in December 2007 in South Africa; (c) capacity development workshop on vulnerable groups in January 10-13, ‘08 in South Africa; (d) TB/HIV integration capacity development workshop in March 2008, and (e) Consultation on HIV strategic planning and gender mainstreaming for key stakeholders in April 2008 in Madagascar.
2006 AIDS epidemic update, UNAIDS December 2006 edition (all prevalence figures quoted are from this report). “ Financial Resources required to Achieve Universal Access to HIV, Prevention, Treatment, Care and Support” report, UNAIDS September 2007 available at http://data.unaids.org/pub/Report/2007/20070925_advocacy_grne2_en.pdf The Inter-Governmental Authority on Development (IGAD) includes Djibouti, Eritrea, Ethiopia, Kenya, Somalia, Sudan and Uganda. For further information please contact:
Shilpa Challa, (202)458-5897 Last Updated November 2007 |
| |  |  9,000 Africans are newly infected each day | | | more than
1 of every 10 adults is HIV-positive | | | | 40% of today's 15-year olds will ultimately acquire HIV/AIDS | | | | 60% in countries such as South Africa and Zambia. | | | | |
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| Regional Initiatives: | | Abidjan-Lagos Transport Corridor HIV/AIDS Project ($16 million) was approved in November 2003 and supports activities for truckers, migrants, sex workers, and local communities along 5-country corridor (Benin, Côte d’Ivoire, Ghana, Nigeria and Togo). Togo, a non-accrual country, was granted an exception and permitted to take part in the Abidjan-Lagos Corridor. | | The Great Lakes Initiative on HIV/AIDS Support Project (GLIA) for $20 million was approved in March 2005 to add value to national efforts, and support interventions for mobile groups including refugees, internally displaced people and returnees. It provided seed capital for the formation of a regional institution, wholly owned by its member States. It involves UNHCR as an implementing partner as well as UNAIDS. GLIA countries are Burundi, Democratic Republic of the Congo, Kenya, Rwanda, Tanzania and Uganda). | | Southern Africa HIV/AIDS Transport Corridor Project would provide support to the world’s most affected region, including Malawi, Zambia, Zimbabwe, Mozambique and South Africa, to address coordination, monitoring and evaluation, and long-haul transport sector and key transport located communities. | | Horn of Africa Support Project would contribute to regional harmonization of prevention, treatment, and support, and interventions reaching large numbers of migrant populations (seven countries would be covered). |
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