Debrework Zewdie, an Ethiopian national and former medical scientist, has been appointed as the World Bank's first Global HIV/AIDS Adviser, with responsibility for intensifying the Bank's work in the field, and representing the Bank in the global movement of governments, communities, private companies, development agencies, and civil society groups determined to throw back an epidemic that World Bank President James Wolfensohn has described as " a catastrophe for development."

"We believe this new position under Debrework Zewdie will help to galvanize our efforts even more to make a difference in developing countries which are struggling with the social and economic ravages of HIV/AIDS, and to raise global awareness and resources to combat and prevent the disease," says Jozef Ritzen, World Bank Vice President for Human Development. "Given her extensive development experience in Africa, and her personal dedication to this issue, I believe Dr. Zewdie will make an immediate impact in her new position."

As Manager of the Bank's AIDS Campaign Team for Africa (ACTafrica), Zewdie was responsible for the Multi-Country HIV/AIDS Program (MAP) for Africa. The MAP program, set up 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 African countries such as Burkina Faso, Cameroon, Eritrea, Ethiopia, Gambia, Ghana, Kenya, Nigeria and Uganda, expand effective prevention, care, and treatment measures. In addition, 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.

The World Bank has been working with partners such as MTV to increase HIV/AIDS awareness in young people.In observance of World AIDS Day, MTV Europe, in association with the Kaiser Family Foundation and in partnership with the World Bank and UNAIDS, is releasing Staying Alive 3¯a 30 minute documentary that profiles young people from around the world infected with or affected by HIV/AIDS. Visit www.staying-alive.org for more information and for MTV viewing times in your area.

"Men and AIDS" has been the general theme for World AIDS Day for two years running. This year, however, "Men and AIDS" will focus on new issues. The UNAIDS campaign slogan this year is "I care. Do you?" The Campaign aims to stress the need for men to care for themselves as well as their partners and children and focuses on the role of men, particularly young men, in the response against AIDS.

As one of eight co-sponsors of UNAIDS, the Bank is playing a role in shaping the global response to the HIV/AIDS epidemic. On January 1, 1996, UNAIDS began its expanded, multi-sectoral United Nations response to HIV/AIDS, which has since expanded to a partnership inclusive of governments, NGOs, and the private sectors. The eight co-sponsoring organizations are the World Bank, the United Nations Children's Fund (UNICEF), the United Nations Development Programme (UNDP), the United Nations Population Fund (UNFPA), the United Nations Education, Scientific and Cultural Organization (UNESCO), the World Health Organization (WHO), the United Nations International Drug Control Programme (UNDCP) and the International Labour Organization (ILO).

New World Bank funding for HIV/AIDS

In a second stage of the MAP program, the World Bank will soon consider offering another installment of $US 500 million to help combat the HIV/AIDS epidemic in Africa, home to an estimated 25 million out of 36 million HIV-positive people worldwide. The new money would be in the form of no-interest International Development Association (IDA) loans. 20 African countries have asked to be included in MAP 2, in addition to the ten countries covered under MAP 1.

The World Bank and UNAIDS estimate that approximately $3 billion is needed every year to fund basic prevention, care and treatment programs across the continent. Part of the new funds will be used to finance cross border projects.

The Caribbean has launched a similar effort. The region's HIV/AIDS infections may have reached 12 percent in some urban areas, a rate comparable to some of the worst-affected countries in Sub-Saharan Africa. In fact, HIV/AIDS has become the major cause of death among men under the age of 45. Official figures show more than 360,000 people living with HIV/AIDS, but estimates place the number at over 500,000, due to underreporting. More than 80,000 children have been orphaned by the epidemic, and the infection rate is estimated to have reached 12 percent in some urban areas, spreading in many countries from high-risk groups to the general population.

In June this year, the Bank approved a $155 million five-year loan program for the region which allows individual countries to obtain separate loans or credits (from the International Development Association) to finance their national HIV/AIDS prevention and control projects. The program is based on widespread participation to facilitate government relations with patients, community groups, religious organizations, non-governmental organizations, health professionals and the private sector. The first loans to support the multi-country programa US$25 million to the Dominican Republic and US$15.5 million to Barbados- were also approved on June 28, 2001.

There are approximately 2.5 million people living with HIV/AIDS in East Asia and Pacific (EAP). Although the overall adult prevalence rate for EAP is still low (less than 1 percent), the region is characterized by pockets of concentrated/generalized epidemic. Cambodia, Myanmar and Thailand now have adult prevalence rates well above 1 percent. The South East Asian Sub-region alone accounts for 70 percent (or 1.7 million) of the total number of people living with HIV/AIDS in EAP.

With risk factors such as extensive commercial sex, illicit drug use, migration and mobility within and across borders in the region, the epidemic has the potential to grow in EAP. For example, the annual growth in HIV infections is as high as 30 percent in China. The total number of people living with HIV/AIDS in China, which stood at 600,000 in 2000, could well exceed one million by the end of 2001.

The Bank has been actively taking part in HIV/AIDS control activities in EAP. Cumulative Bank assistance in HIV/AIDS in the region amounts to US$ 80.7 million. A US$ 38 million project to improve blood safety in Vietnam is currently under preparation. The Bank has also stepped up sector work and policy dialogue related to HIV/AIDS issues in EAP.

South Asia has approximately 4.2 million people living with HIV/AIDS. The region is characterized by high risk but low prevalence rates. While overall rates remain low, below 1 percent of the adult population, the region's large populations mean that a rise of a mere 0.1 percent in the prevalence rate in India would increase the total of adults living with HIV by half a million persons. The World Bank initiated its assistance to South Asia to confront HIV as early as 1992, starting with a credit to support program development in India. Individual country strategies are being pursued in South Asia rather than a MAP program arrangement because of the large size and fewer number of countries such as India, Bangladesh and Pakistan. Bank assistance to South Asia for HIV/AIDS prevention and control aggregates at US$382 million. New projects for AIDS prevention and control are currently being developed for both Sri Lanka and Pakistan.

In other regions, such as Europe and Central Asia*, the number of persons living with HIV/AIDS has dramatically increased, to 700,000, over the past decade. One-quarter of the infections are believed to have occurred in the past three years. Particularly high rates of infection—as high as 65 percent—have been found in sub-groups that engage in high-risk behaviors especially intravenous drug users. While national rates of adult prevalence—less than one percent of the general population—are considered low by international standards, the particularly worrying aspect is the high rate of increase in cases over recent years. The world's steepest HIV curve in 1999 was recorded in the Russian Federation, where the proportion of the population living with HIV doubled between end-1997 and end-1999.

The World Bank has committed more than US$1.7 billion to combating the spread of HIV/AIDS around the world. Its HIV/AIDS lending has risen significantly as more countries have turned to the Bank for financial and technical assistance in response to the epidemic.

The Bank is an active partner in the International AIDS Vaccines Initiative (IAVI), a non-profit organization established by the Rockefeller Foundation. IAVI's mission is to ensure the development of safe and effective vaccines for use throughout the world by stimulating investment and demand.

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.

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 capitaGDP in some of the hardest hit countries may drop by as much as 8 percent.