The Eastern Europe and Central Asia Region (ECA) is experiencing one of the world’s fastest-growing HIV/AIDS epidemics. According to UNAIDS, ‘the number of people living with HIV in the region rose to an estimated 1.6 million in 2007, with an estimated 150,000 new HIV infections. Some 55,000 people died of AIDS related illnesses in the region in 2007.’ 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. Drug trafficking routes also fuel the epidemic in Central Asian Countries. In the countries of the former Soviet Union, prisons represent an important battlefield in fighting HIV and AIDS. Infection rates are higher in prison due to a greater HIV prevalence in persons entering prison, and risk taking during incarceration, whether sexual or needle sharing behavior. In light of this, current intervention efforts in prisons need to be scaled up and strengthened. HIV/AIDS is also contributing to the spread of Tuberculosis (TB) in the region. 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 US$240.5 million across 4 projects: Central Asia AIDS Control (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 November 2005. Funds are being channeled through the Europe and Asia Economic Cooperation Council (EurAsec). Moldova AIDS Control (US$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. Russian TB/AIDS Control (US$150 million) approved in April 2003. Total cost: $286 million. Ukraine TB/AIDS Control (US$60 million) approved in December 2002 has faced tremendous difficulties in its implementation due to lack of strong leadership and weak implementation capacity. The Bank is working with the authorities to find a new more effective way of delivering results. 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.
The implementation of the projects in Moldova and in the Russian Federation is contributing to intended outcomes. HIV prevalence among tested IDUs in Moldova decreased by 30% between 2005 and 2006, while in the Russian population the percentage of HIV-positive pregnant women who received ARV drugs increased by 11.4% since 2003. Additionally, TB mortality in the Russian Federation experienced a 11.4% reduction in 2006 compared to 2005. In additional to projects working to prevent infections, the Bank has completed the following Analytical work in 2005-06: HIV/AIDS Control in prison systems in the Baltic States and the Commonwealth of Independent States: A Literature Review Central Asia HIV/AIDS and IDU study Assessment of best practices in HIV/AIDS Harm Reduction Programs among civilian population and prisoners in the Russian Federation (in partnership with Open Health Institute Study of the Economic Impact of HIV/AIDS in Ukraine HIV/AIDS in the Western Balkans: Priorities for Early Prevention in a High Risk Environment Truck Drivers and Casual Sex: An Inquiry into the Potential Spread of HIV/AIDS in the Baltic Region Reversing the Tide: Priorities for AIDS Prevention in Central Asia Combating HIV/AIDS in Europe and Central Asia
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.”
Priority Areas for Action Sustained funding for HIV/AIDS programs & health sector. The Bank strives to provide continued and sustained funding for national and regional HIV/AIDS programs, especially to fill funding gaps. The Bank also works to strengthen health systems and to support effective, sufficient scale and scope of HIV/AIDS responses to make a difference on the ground. Support stronger strategic, prioritized national planning. The Bank provides support for improving national HIV/AIDS strategies and plans to ensure they are truly prioritized, evidence-based, integrated into development planning and can ultimately be implemented. Accelerate implementation. The Bank is working towards accelerating implementation of national programs, to scale up and strengthen Government efforts and to generate targeted outcomes and results. Build monitoring and evaluation systems & capacity. Strengthening country monitoring and evaluation systems and evidence-informed responses, to enable countries to monitor, manage, assess and improve their programs. The Global AIDS Monitoring and Evaluation Support Team (GAMET), set up by UNAIDS and located at the World Bank, actively works with countries and a wide range of donors, providing practical, hands-on support to strengthen national monitoring and evaluation systems and capacity. Impact evaluation and analytic work to improve HIV/AIDS knowledge and improve programs. The Bank seeks to improve knowledge generation and evaluation of what works, as well as other analytical work to improve program performance.
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, UN agencies, the private sector, and CSOs; 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 Partnership Strategies, Development Policy Reviews, Poverty Assessments, and other non-lending activities such as those supporting Poverty Reduction Strategy Papers.
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For more information on the World Bank’s program on HIV/AIDS control in ECA, please visit: http://www.worldbank.org/eca/aids Contact:
Michael Jones, ECA Region
Telephone: (202) 473-2588
mjones2@worldbank.org Updated December 2007
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