Experts Discuss the Changing HIV/AIDS Landscape in Africa
at the XVII International AIDS Conference
New report highlights the need to adapt to new realities

 

Mexico City, August 4, 2008 — A World Bank report launched today highlights how the AIDS epidemic and environment are rapidly evolving and emphasizes the need for a localized, evidence-informed response to HIV/AIDS in Africa. The Changing HIV/AIDS Landscape explores a wide range of issues, from transmission dynamics to economic development to the financial sustainability of HIV/AIDS interventions in a complex donor environment. The report's findings underscore the need for even more global and country-level political commitment and leadership. The Bank commissioned the papers in the report in order to develop its new Africa HIV/AIDS strategy. Several of the authors are gathering at the International AIDS Conference in Mexico City today to discuss the findings and how they can be addressed.

Given how quickly the epidemic is changing, all global and local partners-including the Bank-must seek to better understand the drivers of the epidemic and "make the money work" for beneficiaries. Resources must be invested in effective interventions that are most likely to work given the characteristics of the local epidemic. Through analytical work contained in The Changing HIV/AIDS Landscape and the Africa HIV/AIDS Agenda for Action, the World Bank has committed to play an important role in assisting countries to make all HIV/AIDS funding work better and accelerate the achievement of the Millennium Development Goals.

"We cannot talk about more inclusive and sustainable development in Africa without also committing to the long-term battle against AIDS, the largest single cause of premature death on the continent," said World Bank Group President Robert B. Zoellick.  “We can see where countries are starting to gain the upper hand against AIDS, and we need to learn from these examples, multiply these results, and be unrelenting in fighting this disease.”

Since 2000, the World Bank has provided more than US$1.6 billion to more than 30 countries in sub-Saharan Africa to combat the epidemic.

The new report provides insights into the new epidemiological realities and challenges some commonly held views. Questioning "conventional wisdom" on HIV/AIDS forces policy makers to rethink and debate prevention policies. This is crucial because misconceptions about the epidemic can seriously hamper efforts to fight the disease.

Some of the Changing HIV Landscape's critical findings include:

• A key reason for health care workers leaving government service is lack of protection from HIV, including standard protective equipment and access to post-exposure prophylaxis.
• Poverty is usually associated with HIV/AIDS, but, at the individual level, HIV/AIDS is associated with behaviors and characteristics demonstrated by higher-income people, such as having more concurrent sexual partners, geographic mobility, and urbanization.
• Lifetime treatment costs about US$5,600 in Africa, while the cost to prevent a new infection is about US$2,000 and is expected to decrease over time.

The report enhances understanding about issues such as:

• Infection rates continuing to outpace access to treatment, with five new infections for every two people able to access treatment.
• The need to integrate HIV/AIDS services into general and reproductive health services, given the rates of tuberculosis co-infection and the too-often missed opportunity to address HIV/AIDS when women seek health care, for example.
• The critical role of communities in achieving universal access to prevention, care, and treatment.

"Health systems that work effectively and efficiently are also critical for universal access," says Elizabeth Lule, manager of the Bank's AIDS Campaign Team for Africa (ACTafrica). "Without them, we are unlikely to achieve universal access to treatment." She adds, "Increases in HIV/AIDS funding offer prime opportunities to strengthen broader national systems and build civil society's capacity to address the social drivers of the epidemic such as gender inequalities."

The report concludes that nations, donors, and communities must understand their specific epidemics, rely on evidence to determine appropriate interventions, and coordinate much better when setting priorities.

Background: The World Bank's Agenda for Action on HIV/AIDS in Africa

By 2006, it was clear to World Bank leadership in Africa that much had changed, that countries and partners had entered a new phase, and that the Bank needed to rethink its approach, adjusting to the new environment on the ground as well as to other changes taking place. ACTafrica undertook a major consultation process to develop its new approach, moving from an emergency response to a long-term, sustainable approach. This effort culminated in a new strategy for a multi-partner, multi-sectoral response to the AIDS situation in Africa: The World Bank's Commitment to HIV/AIDS in Africa: Our Agenda for Action, 2007 - 2011.

The Bank's new strategic objectives in this area include: advising countries on how best to integrate HIV/AIDS in their national development agendas, helping countries to accelerate implementation and take 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 stronger health and fiduciary systems. Implementation of the new strategy began in late 2007.

The World Bank is one of ten co-sponsors of UNAIDS, along with ILO, UNHCR, UNICEF, UNDP, UNESCO, UNODC, UNFPA, WFP, and WHO.

# # #

For more information on the World Bank's HIV/AIDS work in Africa, visit: www.worldbank.org/afr/aids