 World Bank and HIV/AIDS in Europe and Central Asia
The Eastern Europe and Central Asia Region (ECA) is experiencing one of the world’s fastest-growing HIV/AIDS epidemics. According to UNAIDS, in 2005, 270,000 people in ECA became newly infected with HIV, bringing the number of people living with HIV/AIDS to approximately 1.6 million. This marks a 25 percent increase from 2003. An estimated 62,000 people lost their lives to HIV/AIDS this year alone. The majority of people living with HIV are in the Russian Federation and Ukraine, where the combination of injecting drug use and sex work is fuelling the epidemic. The patterns of the epidemic are changing in several countries,with sexcually transmitted HIV cases making up a growing share of new diagnoses, for example in Kazakhstan, Belarus and Moldova. Across the region, young people are disproportionately affected, with an estimated 75 percent of reported infections between 2000 and 2004 in those under the age of 30. Tuberculosis (TB) is epidemic in the region , combining dangerously with HIV/AIDS. HIV-positive people with weakened immune defenses are especially vulnerable. Indeed, HIV drives TB’s spread, particularly in prisons and other highly affected areas, by promoting progression to active TB among those who have latent tuberculosis infections. World Bank Support in ECA The World Bank’s lending to tackle HIV/AIDS and TB in ECA includes:
• The Ukraine TB and AIDS Control Project (a US$60 million loan), approved in December 2002. Total cost: $77 million.
• The Russian Federation TB and AIDS Control Project (a $150 million loan), approved in April 2003. Total cost: $286 million.
• The Moldova AIDS Control Project (a $5.5 million grant from the International Development Association), approved in June 2003. Total financing for National TB/AIDS/STI program, of which the AIDS Control project is a part: $14.7 million, of which $5.2 million is from the Global Fund to Fight AIDS, TB and Malaria. Remaining financial support is coming from USAID and the government itself.
• Central Asia AIDS Control Project (a $25 million equivalent IDA grant and a $1.9 million grant from the UK’s DfID). Approved in March 2005, this $26.9 million project covers Kazakhstan, Kyrgyz Republic, Tajikistan and Uzbekistan. The project became effective in November 2005. Funds are being channeled through representatives of the Central Asia Cooperation Organization, or CACO. Of the four operations listed above, the Moldova project is most advanced, with treatment and prevention measures now benefiting prison populations and other at-risk groups. The Ukraine project is supporting a public information campaign targeted at youth; under the Russia project, the essential step of completing HIV/AIDS and TB needs assessments for 89 regions has been completed. In Uzbekistan, the Bank has been helping the government with a Health II project, which includes an HIV/AIDS component. In the Kyrgyz Republic, the World Bank is helping to implement a Health II Project and recently completed a nationwide attitudinal survey of adults to test attitudes and awareness about HIV/AIDS. In Turkey, the World Bank is helping the government assess the national surveillance system for HIV/AIDS. HIV/AIDS control is included in the Poverty Reduction Support Credit in Albania, where a nationwide opinion poll on attitudes about HIV/AIDS was also conducted.
Research and analytical work has taken the form of a 2003 Regional Strategy as well as sub-regional studies in South Eastern Europe, the Western Balkans, Central Asia, and in Poland and the Baltic States. Country-specific work has included a Georgia Country Study and an analysis of the economic impact of AIDS in Russia. Joint work with the Clinton Foundation, WHO and UNAIDS on drug patent legislation and drug registration procedures Russia has also been undertaken.
Potential Costs of Inaction The uncontrolled spread of HIV/AIDS could have devastating consequences on health and economic growth in the region. A generalized epidemic among economically active age groups could result in:
• A decline in annual economic growth rates by 0.5–1.0 percentage point
• A 1–3 percent increase in health expenditures
• A rise in the dependency ratio, putting a strain on social protection systems, especially in countries already experiencing declining total fertility rates, such as Belarus, Estonia, Moldova, and the Russian Federation.
• Increased vulnerability among households as children are forced to drop out of school to work or take care of siblings, reinforcing the “poverty trap.” The way ahead Recently, the Eastern Europe and Central Asia region has experienced a more than twelve-fold increase of international assistance - from US$ 52 million in 2001 to more than US$ 600 million by the end of 2005 through the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), the World Bank and major bilateral donors. With this funding increase, and the potential for a sharp reduction in prices for antiretroviral drugs, a massive and rapid expansion of prevention and treatment programs is now becoming financially feasible. Tailoring assistance to suit country needs; improving coordination. As countries in the region vary in terms of income, dependence on foreign aid, and local human capacity for tackling the epidemic, further country level studies are required to identify the most pressing local needs and the most suitable instruments for assistance. The GFATM has approved grants to 19 countries in ECA. With more donors, NGOs, and foundations turning their attention to HIV/AIDS in ECA, careful coordination of aid as well as social marketing and health interventions are essential. For its part, the World Bank acts as a trustee and ex-officio partner of the GFATM. Scaling up current pilot projects to include prevention programs that target people at high risk as well as their partners. Interrupting HIV transmission among people at high-risk core as well as to those with whom they have intimate contact is crucial to avert a generalized epidemic in the region. This means targeting injecting drug users, mobile populations, and commercial sex workers and their sex partners. Short- and medium-term actions that will be the focus of World Bank efforts include:
• Adopting policies and programs that help reduce the risk of becoming infected,
• Improving surveillance as a basis for effective interventions,
• Improving awareness of HIV/AIDS among the general population,
• Adopting large-scale prevention programs,
• Adopting treatment programs designed to prevent the emergence of drug-resistant forms of TB and HIV. Medium or long term actions. The deep-seated and complex factors that lead to the spread of HIV need to be dealt with through:
• Fostering sustained, pro-poor economic growth through poverty-reduction policies and programs,
• Controlling drug trafficking,
• Reducing overcrowding in prisons through effective judicial reforms,
• Improving employment opportunities for young adults,
• Curtailing human trafficking, and
• Improving testing, counseling, and TB control through better public health infrastructure. Priority Areas for Action Raising Political and Social Commitment. The Bank will continue efforts to raise political and economic commitment for HIV/AIDS and TB control, including through regional- as well as country-specific initiatives. Examples include a Russian Business Summit on HIV/AIDS held in the Spring of 2005 and a Commonwealth of Independent States ministerial meeting on HIV/AIDS from March 31-April 1 in Moscow, organized by UNAIDS and its co-sponsors.
Preventing HIV and TB Infections. In partnership with other specialized agencies that are also under the UNAIDS group, high-priority will be accorded to: increasing blood safety, promoting ‘harm reduction’ (including needle and syringe exchange programs, drug dependency treatment and rehabilitation, and 100 percent condom use programs); working with partners to support HIV/AIDS in the workplace programs; and promoting programs for commercial sex workers and their clients as well as for prison inmates and ex-inmates. Ensuring sustainable treatment and good quality care. Medical treatment and psychosocial support, including palliative care, and highly active antiretroviral therapy, are essential. Facilitating Large-Scale Implementation. As countries scale up pilot projects, the following actions are necessary for large-scale programs to be effective:
• Improving surveillance systems;
• Improving high-level political support for HIV/AIDS and TB control;
• Identifying and overcoming legal barriers to large-scale programs;
• Conducting operational research, with emphasis on behavioral change;
• Conducting vaccine preparedness studies; and
• Conducting country-by-country analyses of financial and non-financial resource gaps, with a view to identifying ways to narrow them. The World Bank’s Approach The Bank’s support for HIV/AIDS and tuberculosis control in Eastern Europe and Central Asia will focus on four areas:
• Continued work in partnerships with governments, UNAIDS, the private sector, and CSOs;
• Collaboration with specialized institutions to support the adaptation of lessons learned from global experiences to Eastern Europe and Central Asia as appropriate;
• Multisectoral and multidisciplinary support for priority actions at the country, sub-regional, and regional levels; and
• Deployment of a variety of instruments for policy dialogue and analytical and advisory services for more intensive work on HIV/AIDS and tuberculosis in the region, including Country Assistance Strategies, Development Policy Reviews, Poverty Assessments, and other non-lending activities such as those supporting Poverty Reduction Strategy Papers. For more information on the World Bank’s program on HIV/AIDS control in ECA, please visit: http://www.worldbank.org/eca/aids Contact:
Merrell Tuck-Primdahl, Senior External Affairs Officer, ECA Region
Telephone: (202) 473-9516
e-mail: Mtuckprimdahl@worldbank.org |
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