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Turning The Tide Against HIV/AIDS

Calling HIV/AIDS "a catastrophe for development" that is reversing life expectancy by decades in some countries, World Bank President James D. Wolfensohn appealed yesterday to government and business leaders, charitable foundations and other groups attending next week's United Nations General Assembly Special Session on HIV/AIDS (UNGASS) to mobilize their political and financial support behind a global action plan to fight the spread of AIDS.

More than 36 million people are now living with HIV/AIDS worldwide, 95 percent of them in developing countries. 21.8 million people have died already from the disease, 4.3 million of them children. Last year alone, 5.3 million people became newly infected with HIV.

"HIV/AIDS is no longer just a health problem, but a global development problem, threatening to reverse many of the gains made over the last half century,"  Wolfensohn said. "There is simply no reason why generations of people should disappear as a result of AIDS when a determined global movement of governments, communities, private companies, development agencies, and civil society groups can make a dramatic difference. AIDS is an international security problem, and as such, it needs a war chest and a rigorous strategy for achieving results."

World Bank research shows that the development impact of HIV/AIDS has been devastating, not only on families, communities, and regions, but also on peoples' livelihoods and national economies. The Bank estimates that annual per capita growth in half the countries of sub-Saharan Africa, the region worst hit by the epidemic, is falling by 0.5-1.2 percent as a direct result of AIDS and that by 2010, per capita GDP in some of the hardest hit countries may drop by as much as 8 percent.

While money alone will not solve the problem, it is a vital part of the solution, and funds earmarked for confronting the epidemic are currently much too low. Although dramatic reductions in prices of anti-retroviral drugs are key to treatment, at $400 - $500 a year, down from $10,000, they are more affordable, but still well out of reach for the vast majority of infected people in developing countries where per capita income is less than $500 per year, and where many governments spend less than $5 per person on healthcare.

Overall external aid declined throughout the 1990s, to a new low as a share of donor countries' collective GDPs. Although the proportion of ODA committed to HIV/AIDS grew during this time, this growth was largely offset by the overall decline in aid. The Joint United Nations Program on HIV/AIDS (UNAIDS), of which the Bank is a co-sponsor, estimates that a basic HIV/AIDS program in all developing countries would cost at least $9.2 billion per year—six times the current level of investment which is approximately $1.5 billion a year. This estimate does not include the cost of improving the health infrastructure in developing countries, an important ingredient for a successful response.

To turn back the epidemic and reduce its impact, the World Bank says that funding from rich countries, private business leaders, charities, and other sources needs to be substantially increased, and countries need to become the architects of their own AIDS-fighting strategies, which must draw heavily on popular support and active community leadership to achieve any chance of success.

"In throwing their weight behind a global trust fund for the prevention and treatment of HIV/AIDS and other communicable diseases, rich countries must ensure that their pledges of financial support represent genuinely new money over and above existing volumes of foreign aid," said Wolfensohn. "To reallocate existing funds would simply be a shell game. I hope and trust that they will respond generously to the challenge of throwing back the spread of HIV/AIDS and contribute significantly to the war chest that will be needed".

Wolfensohn also said that civil society organizations should be invited into the global campaign against HIV/AIDS. Its contribution to the campaign could be enormous, he said.

"Civil society has played a pivotal role in all countries that have had success against HIV/AIDS. At the global level, representatives of civil society should be involved at all stages in the design, decision-making, and implementation of HIV/AIDS-related activities. At the country level, civil society should also play a significant role in any national AIDS-fighting strategy, and a large share of HIV/AIDS resources should go to the local level and to community organizations." 

World Bank Lending on AIDS

Over the past year, the World Bank has committed more resources to combating the spread of HIV/AIDS than ever before. This follows a pledge made by Wolfensohn last year that no country with a credible HIV/AIDS program in place would go without funding from the World Bank.

Between 1996 and 2000, the Bank committed approximately US$493 million for new HIV/AIDS components and stand-alone projects in 39 countries. By the end of this fiscal year, the Bank will have committed an additional US$740 million for new HIV/AIDS prevention and care efforts, mostly in Sub-Saharan Africa.

The World Bank, in collaboration with UNAIDS, the International Partnership Against AIDS in Africa, key bilateral donors, and leading NGOs, has launched the first phase of the Multi-country AIDS Program (MAP) for Africa, which over the past year has provided $500 million in new money to help ten African countries scale up effective prevention, care, and treatment. The MAP makes significant resources available to civil society organizations and communities, which have developed some of the world's most innovative HIV/AIDS interventions. It is expected that $500 million more will be made available next year to reach another 15 African countries.

A similar effort is being carried out in the Caribbean, where HIV/AIDS infections may have reached 12 percent in some urban areas, an infection rate comparable to some of the worst-affected countries in Sub-Saharan Africa. Next week, the World Bank's Board will consider a $155 million, five-year program for the region. Although most Bank assistance focuses on prevention, some loans also support improvements in treatment for people living with HIV/AIDS. Under the impending Caribbean program, Barbados would become the first country to receive Bank assistance to finance the use of anti-retrovirals—a cocktail of drugs that vastly reduces HIV levels in the blood—allowing people to live healthier and longer lives.

In addition to financial support, the Bank is helping developing countries to put   HIV/AIDS prevention and treatment efforts in the forefront of their poverty reduction strategies. The Bank is also assisting poor countries which have benefited from debt relief under the World Bank Heavily Indebted Poor Countries Initiative (HIPC)  to devote a share of their subsequent savings to prevention and care for people suffering from the disease. For example, debt relief resources are now programmed to finance HIV/AIDS efforts in Burkina Faso, Malawi, and Uganda.

Useful links: For more information on the Bank's participation at the UN Special Session on HIV/AIDS please visit:

For more information on the World Bank's work on AIDS, visit:

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