Global AIDS Epidemic Shows No Sign of Abating

December 1, 2003 - Today people around the world will mark World AIDS Day and call for efforts to roll back the epidemic. But the global AIDS epidemic shows no signs of abating-in fact HIV infections and deaths are at their highest levels ever. According to the latest UNAIDS update, released last week, 5 million people became infected with HIV worldwide and 3 million died this year alone-the highest ever. Below the World Bank director of HIV/AIDS programming Debrework Zewdie talks about the state of the epidemic and the World Bank's response.

What is the current state of the global AIDS epidemic?

According to UNAIDS latest yearly estimates that come out every World AIDS Day, the AIDS epidemic shows no signs of tapering off. This year alone, 5 million people became infected worldwide and 3 million died—the highest-ever number in any year. While more people have become newly-infected with HIV/AIDS this year, the total number of people who are now living with the disease is lower than previously thought, now estimated at 40 million.
UNAIDS believes that one of the main reasons for the trend is that more countries now have better AIDS surveillance systems in place. Also, UNAIDS and WHO get access to more reliable data these days. So we see more newly-infected people living with HIV/AIDS, which is the trend of the epidemic. A number of countries, such as Vietnam, show rising trends and this situation will become much more significant as we move forward.

How have the World Bank's HIV/AIDS programs changed in the last year?

The Bank's program has changed substantially in the past year. Two years ago, the Bank focused on making sure that the Bank's programs in the two worst-affected regions, Sub-Saharan Africa and the Caribbean, had resources available to them. We wanted to ensure that these regions were able to scale up their programs. Implementing programs is something that the Bank has taken very seriously, that has meant changing the Bank's way of doing business, for example, by revising some of the regulations that appeared to be bottlenecks on our side.

In the last year, we have made sure that the Bank puts its technical and financial resources into programs on the ground, and implemented adequately. The Bank's Multi-Country HIV/AIDS Programs (MAP) also complement efforts made by other donors, such as the Global Fund to fight AIDS, Tuberculosis and Malaria's program as well as the US Government's Emergency Plan for AIDS Relief Initiative. The Bank establishes good fiduciary structures on the ground, making sure resources reach grass roots levels.

One of the successes of the MAP in Africa is to be able to reach thousands of grass roots organizations and communities that have never been reached before. We also make sure these national programs can implement their programs on the ground. Additionally, we have increased our efforts in other regions where the epidemic is still in its early stages, but still has the potential to increase rapidly, as is happening in many areas.

What are the biggest challenges to implementing HIV/AIDS programs on the ground?

We have taken the initiative in the Bank to simplify its procedures. We would also like to have seen governments simplify their procedures as well. The MAP is one of the most flexible instruments working on HIV/AIDS programs on the ground, but we are still bogged down by government rules and regulations. If unnecessary rules and regulations are removed, the Bank and other donors would be able to improve programs even further than we already have, making programs more effective on the ground. We need to continue educating both Bank staff and our client countries as to how easy, simple and flexible the MAPs are in both Sub-Saharan Africa and the Caribbean. The Bank is ready to look into its rules and regulations further in order to ease implementation.

Thirdly, and perhaps most worrisome, is that a number of people the Bank has trained to implement the MAP programs are the same people who are preparing programs for the Global Fund and who will be preparing programs for the US Government's Emergency Plan for AIDS Relief Initiative. These people are pulled in several different directions, which imposes a tremendous burden on implementing programs on the ground. The international community needs to coordinate its efforts to lessen programming burdens on countries. The Bank is working on improving interaction among partners and other donors.

How are UNAIDS, WHO and other partners working together to curb the epidemic?

The nine UNAIDS co-sponsors, including the newest member, the World Food Programme (WFP), are all working together to implement programs on the ground around the world. We are all making a tremendous effort to work together to meet the very ambitious goals and challenges of curbing HIV/AIDS the epidemic. There is more of a sense of cohesion among the UNAIDS partners now than ever before in order to implement programs on the ground, so that all of global programs succeed. There are millions of people who need our support, so we are trying to make sure that all of the global programs and initiatives are working together better than before.