At a Glance - The World Bank offers long-term support to countries for the effective prevention of new HIV infections, care and treatment for infected people, and alleviating the devastating social and economic consequences for affected families and communities.
- In the last three years, the Bank has committed almost US$1 billion through grants, loans, and credits to HIV programs. Total Bank financing for HIV/AIDS since 1988 is more than US$4.2 billion. The Multi-Country HIV/AIDS Program (MAP) for Africa has made available US$1.9 billion to 35 countries, including five sub-regional (multi-country) initiatives.
- Expanding access to life-saving antiretroviral treatment to 4 million people and crucial prevention efforts are now jeopardized by the global economic crisis. Declining external aid for AIDS, lower government revenues, trade and financial flows and exchange rate depreciations are severely eroding governments’ ability to sustain their AIDS programs. Job and income losses and worsened food security undermine households’ access to treatment and prevention services.
- The Bank coordinates its work with countries and sister development agencies and other partners to expand access to HIV prevention, treatment and care.
Overview AIDS remains a central development challenge. Most of the 33 million people with HIV in 2007 were living in developing countries. AIDS has spread to every country in the world, infected more than 50 million people and killed more than 20 million. AIDS has a unique development impact, because alone among major diseases, it preferentially attacks adults in their most productive years—breadwinners, parents and caregivers. It has already created more than 15 million orphans, 12 million in Sub-Saharan Africa alone. The UNAIDS epidemic update this December will show whether total numbers of new HIV infections and AIDS deaths have continued to fall. Access to treatment has increased dramatically—now reaching 4 million people—double the 2006 number. But many more millions of people still need treatment, with enormous differences in coverage across countries—from below 5 percent to more than 90 percent. The challenge continues to outstrip our response: For every two people placed on lifelong treatment, five become newly infected. Funding to sustain treatment and prevention programs is being affected by the global crisis, jeopardizing hard-won gains. Sub-Saharan Africa continues to be the most seriously affected region, with 68 percent of all new infections. HIV levels are exceptionally high in southern Africa, where more than 70 percent of hospital bed occupancy is AIDS-related, and HIV has increased TB by 250-400 percent. Even where overall HIV prevalence is low, AIDS can be a severe burden: For example, it is the leading cause of premature death in Thailand and China. Despite the perception that AIDS is well-funded, there is a growing financing gap and funding can be volatile, uncertain, and limited in the countries supported and the activities financed. With budgets not keeping pace with AIDS treatment expansion, HIV prevention may be crowded out, despite being absolutely crucial to sustaining treatment. How the Bank HelpsThe Bank is one of the three largest sources of financing for HIV programs. In the last three years (FY2007-2009), the Bank committed nearly US$1 billion to national and regional programs. In addition to large Multi-Country AIDS Programs in Africa, the Caribbean, and Central Asia, there are dedicated AIDS projects in every region, many health sector projects that focus on or include support for HIV and AIDS, and funding for HIV is included in many education, transport, infrastructure, urban development and water and sanitation projects. The Bank supports national, regional and global efforts to prevent new HIV infections, to provide care and treatment for people infected and affected by HIV, and to help families and communities weather the impact of AIDS. We work with partners and major stakeholders striving towards universal access to comprehensive prevention, treatment, and care services, including scaling up access to Antiretroviral Therapy (ART) drugs, which help HIV-positive people stay alive, healthy and productive, and able to raise their children. To help countries achieve stronger results in their HIV responses, we provide strategic analysis, services to strengthen national HIV/AIDS strategies, support for developing functioning systems to monitor and manage national responses, evaluations of what works and what doesn’t, policy advice, and other technical know-how at country level, working closely with partners. Progress is being made in working with the Global Fund and PEPFAR to better coordinate and harmonize our support, through joint missions, activity planning and program evaluations, agreeing that countries can use the same processes and mechanisms irrespective of funding source, and in some countries, by pooling financing. Regions in Focus Sub-Saharan Africa The Multi-Country HIV/AIDS Program (MAP) for Africa is a long-term commitment. The MAP has so far provided US$1.9 billion to increase national HIV/AIDS efforts in 35 countries, including through five sub-regional (multi-country) initiatives: the Abidjan to Lagos transport corridor project; the Great Lakes region initiative; a regional capacity building network for HIV/AIDS; a treatment acceleration project in three countries that tested different approaches to scaling up AIDS treatment and care; and a project in the Horn of Africa to combat HIV among highly vulnerable groups within the Intergovernmental Authority on Development (IGAD) member states: Djibouti, Eritrea, Ethiopia, Kenya, Somalia, Sudan, and Uganda. The Bank recently approved the first HIV/AIDS project in Botswana (US$50 million), MAP “repeater” projects in Nigeria (US$225 million), and Lesotho (US$5 million), and additional financing in Malawi (US$30 million). There are also “MAP Repeater” projects in Benin, Burkina Faso, Burundi, Eritrea, Ethiopia, Ghana, Kenya, and Madagascar, and supplemental funding was also provided in Burkina Faso, Cape Verde, Congo Republic, Mali, Nigeria, and Rwanda. MAP performance has accelerated steadily, with US$1.3 billion disbursed to date. Since 2006, Bank support has helped enable 4.3 million people to receive HIV counseling, testing, and their test results, and 3 million pregnant women to receive antenatal care. Eastern Europe and Central Asia Financial support includes a US$60 million loan for tuberculosis (TB) and AIDS control in the Ukraine; a US$150 million project in the Russian Federation to support TB and HIV control efforts; a US$5.5 million International Development Association (IDA) grant for the Moldova AIDS Control Project; and a grant of US$25 million for a regional project in Central Asia that is supporting electronic HIV Sentinel Surveillance in Kazakhstan, Kyrgyz Republic, Tajikistan, and Uzbekistan in partnership with the U.S. Centers for Disease Control and Prevention. In 13 pilot sites, six surveillance groups (IDU, SW, MSM, patients with STI, prisoners, and pregnant women) are being monitored for HIV, hepatitis C, and syphilis, as well as sexual behavior, injection practices, knowledge, seeking medical help for STI symptoms, and access to prevention programs. The Bank co-sponsored a Business Summit on HIV/AIDS in Russia, and, working with other international partners, Eastern European and Central Asia Conferences on HIV/AIDS in Moscow in 2006 and 2008, and supported public opinion surveys on HIV/AIDS in Albania and the Kyrgyz Republic that informed policy and program development. East Asia and the Pacific Our assistance focuses on using evidence to improve the impact and effectiveness of AIDS programs, in the context of tightening budgets. In Indonesia, a study to track HIV expenditure in urban and rural districts will be used to better understand current resource utilization at the patient and provider level and to inform future resource allocation. In Papua New Guinea, a survey is underway to estimate national and regional HIV prevalence and better understand the behaviors that increase transmission. This, like the recently completed survey in Tanah Papua, Indonesia, will enable resources and prevention effort to be targeted better. Many countries and development partners have asked us to help evaluate HIV/AIDS efforts—impact evaluations are underway in Cambodia, Vietnam, and Thailand in the areas of prevention of mother to child transmission, harm reduction, and cross-border prevention and treatment. There are strong efforts to integrate HIV into the broader public health response in the region. For example, Vietnam’s blood transfusion centers are supported by Bank financing (US$38.2 million). In addition, more than 60 percent of Vietnam’s US$35 million grant for HIV/AIDS goes directly to 20 provinces/cities to develop and implement action programs in line with the National HIV Prevention Strategy. The US$104 million China Tuberculosis Project includes several HIV/AIDS sub-projects, and China’s Health IX project (US$60 million) included components for HIV/AIDS and STI interventions and support, improved HIV/AIDS/STI surveillance, and improved blood transfusion services. The Transport sector incorporates HIV/AIDS education into all Bank-supported projects with civil works components. South Asia In South Asia, the Bank has a multi-sector regional team and action agenda, mainstreaming HIV in key sectors beyond health, such as transport and other infrastructure, education, and the private sector. Through a country-specific approach, the Bank supports policy, lending, analytical, and advisory activities and cross-country learning in the region. This has helped mobilize countries to improve and accelerate their responses to HIV and AIDS, with sustained low national HIV prevalence rates in all countries and encouraging trends in HIV infections in India, which has the third largest number of people living with HIV and AIDS globally. However, concentrated epidemics among vulnerable groups at high risk, driven by sex work, unprotected sex, and injecting drugs use, remain a challenge in all countries of the region. In India, Pakistan, Bangladesh, Bhutan, Sri Lanka, and Afghanistan, we have committed a total of US$661 million in IDA credits and grants to strengthen national programs. The main components of Bank-supported projects are surveillance, monitoring and evaluation, targeted interventions for populations at highest risk, blood safety, stigma reduction efforts, and strengthening public and private institutions. We support functional integration between HIV and reproductive health services, TB programs and other interrelated health problems and programs through regional support to national programs and other operations at different levels. We work closely with the Global Fund, UN agencies, the United Kingdom’s Department for International Development (DFID) and other development partners to ensure complementary funding of national programs. Stigma and discrimination hamper HIV prevention efforts in the region. Latin America and the Caribbean HIV epidemics differ between the two sub-regions and within each sub-region. Unprotected sex between men is a principal mode of transmission in Latin America. Sex workers and injecting drug users, to a lesser extent, are also fueling the epidemic. Unprotected heterosexual intercourse is the main mode of HIV transmission in the Caribbean, and though there are indications that the epidemic is stabilizing, HIV prevalence rates are very high among sex workers and injecting drug users. Stigma, discrimination, and homophobia are major impediments to an effective response The Bank’s current AIDS portfolio in the region totals US$117.6 million: International Bank for Reconstruction and Development (US$78.9 million) and IDA (US$38.7 million). Stand-alone HIV/AIDS projects include the Caribbean MAP (US$97.4 million), which includes new lending in Jamaica (US$10 million) and Barbados (US$35 million), and a project in Central America (US$8.0 million). Health projects in El Salvador, Honduras, and Argentina include HIV components of US$2 million, US$5 million, and US$5 million, respectively. A new report, "Strengthening the Education Sector Response to School Health, Nutrition and HIV/AIDS in the Caribbean Region: A Rapid Survey of 13 Countries," identifies key future interventions. Analytical work has also helped Mexico, Panama, Honduras, and Argentina identify the most cost-effective prevention strategies, assess behavior change communications and options for scaling up the response in the Andean countries, and ways to strengthen the transport sector’s HIV response. A joint multi-organization review (DFID, WHO/PAHO, the Global Fund to Fight AIDS, TB and Malaria, UNAIDS Secretariat and World Bank) assessed national, regional, and international HIV/AIDS responses in the Caribbean, which has the world's highest HIV rate outside Sub-Saharan Africa. A review of legal reforms required to protect children affected by AIDS in Grenada, St. Lucia, Guyana and St. Vincent, and the Grenadines identified “quick win” reforms for the governments to consider. The Bank also assisted Guyana in reviewing all legislation pertaining to health and in drafting a bill for a new HIV/AIDS Prevention and Control Act. Studies in six countries in Central America summarized the epidemiology and national response to HIV/AIDS, establishing a baseline and basis for policy dialogue on challenges and successes and appropriate programmatic responses. The regional HIV/AIDS Project in the Caribbean region has supported a range of HIV research. The Middle East and North Africa The Djibouti AIDS Control Project (financed by an IDA grant of US$12 million) was completed this year and Bank support for HIV/AIDS is continuing through an ongoing health project. The Bank also supported Lebanon’s surveillance capacity and national monitoring and evaluation system (through a US$350,000 grant) and is currently supporting the updating of its national AIDS plan. At the regional level, the AIDS Strategy and Action Planning (ASAP) facility (hosted by the Bank on behalf of UNAIDS) is helping strengthen National AIDS Strategies and Action Plans in Morocco, Lebanon, Algeria and Tunisia. In collaboration with UNAIDS and WHO/EMRO, the Bank prepared a regional synthesis report that updates analysis of data and evidence on the epidemiology and epidemic potential in vulnerable groups and the general population in the region. The report is currently being published for dissemination by year-end. The Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)The GFATM is an independent partnership among public- and private-sector organizations. It works to increase global resources to fight these deadly diseases, which cause nearly 6 million deaths a year. We were an active partner in setting up the GFATM, serve on the GFATM Board, and are working together to support effective, results-focused country responses to AIDS, TB and malaria, including strengthening health systems to deliver these services. Media Contact: Phil Hay, (202) 473-1796, phay@worldbank.org Updated September 2009 |
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