AT A GLANCE: - The World Bank is committed to providing long-term, sustained support for comprehensive national responses to HIV and AIDS, for effective prevention of new infections, care and treatment for infected people, and mitigation of the devastating social and economic consequences for affected families and communities.
- The Bank is fully committed to ongoing harmonization and coordination efforts among a wide group of development partners to better align support for HIV/AIDS with national programs, to be more efficient and effective and achieve better results, and to scale up towards universal access to prevention, treatment and care, within the “Three Ones” principles of one national AIDS Coordinating authority, one national strategic plan, and one national monitoring and evaluation system.
- In the last five years, the Bank has mobilized approximately $1.9 billion through grants, loans and credits to programs to fight HIV/AIDS. The Multi-Country HIV/AIDS Program (MAP) for Africa has made available $1.5 billion to 33 countries, including five sub-regional (multi-country) initiatives. Total Bank financing for HIV/AIDS since 1988 is around $3.7 billion.
Overview AIDS is rapidly reversing hard-won development achievements of previous decades, and therefore prevention, care, and treatment of the disease must be at the centre of the development agenda.
The latest numbers show that the number of people living with HIV continues to increase—33.2 million people in 2007, the vast majority of whom live in developing countries. UNAIDS estimates that every day, more than 6800 people become newly infected with HIV and 5700 die of AIDS, lacking access to the life-saving treatment. About 40 percent of all new adult infections are among young people aged 15 to 24. In some regions, the majority of newly infected people and people living with HIV are women, which underlines the importance of better access to reproductive health services. Clearly, AIDS remains a central development challenge. However, recent hopeful trends continue: the global number of new HIV infections and AID deaths have fallen for several years, and global HIV prevalence (percentage of persons infected with HIV) is remaining at the same level, with longer survival times for people with HIV resulting from increased access to treatment. National HIV prevalence rates have fallen in Côte d’Ivoire, Kenya and Zimbabwe in Africa, and in Cambodia, Myanmar and Thailand. HIV rates have fallen in parts of a growing number of countries. Sub-Saharan Africa continues to be the most seriously affected region, with 68% of all new infections, exceptionally high HIV levels in the southern Africa countries where AIDS remains the leading cause of death. The pandemic has formed two broad patterns: generalized epidemics sustained in the general populations of many sub-Saharan African countries, especially in the southern part of the continent; and epidemics in the rest of the world that are primarily concentrated among populations most at risk, such as men who have sex with men, injecting drug users, sex workers and their sexual partners. Access to antiretroviral treatment has improved markedly, now reaching an estimated 3 million people, about 30%of those who need it -- a 50 per cent increase in the past year and 10-fold rise over six years. But differences in coverage across countries are enormous -- from below 5% to over 90%. Rapid increases in the scale and scope of HIV programs are urgently needed, towards the widely endorsed goal of universal access to prevention, treatment and care. Bank Assistance We are one of the three largest sources of financing for HIV programs. In the last five years (FY2003-2007), we committed approximately $1.9 billion through grants, loans and credits to national and regional programs. For the poorest and most indebted countries, support for HIV and AIDS strategies from our no-interest concessional lending arm (IDA) can be up to 100% grant-financed. In addition to our 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 mitigate the impact of AIDS on families, communities and nations. We are working with our partners and major stakeholders on 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 to survive, live healthy and productive lives, and raise their children. To help countries achieve stronger results in their HIV responses, we provide strategic analysis, services to strengthen national HIV/AIDS strategies, hands-on support for developing functioning systems to monitor and manage national responses, 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, pooling financing. Regions in Focus Sub-Saharan Africa Our Multi-Country HIV/AIDS Program (MAP) for Africa is a long-term commitment to support HIV/AIDS programs in as many countries as possible, strengthening and increasing prevention, care and treatment programs, and reducing the effects of the epidemic in all sectors. It has so far provided about $1.5 billion to increase national HIV/AIDS efforts in 33 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 is testing different approaches to scaling up AIDS treatment and care; and the newest sub-regional project in the Horn of Africa. This is the first grant financed by the Africa Catalytic Growth Fund (ACGF), and is dedicated exclusively to combating HIV/AIDS among highly vulnerable groups, within the Intergovernmental Authority on Development (IGAD) member states: Djibouti, Eritrea, Ethiopia, Kenya, Somalia, Sudan and Uganda. The Bank approved “MAP Repeater” projects in 2005 for Eritrea ($24 million), Madagascar ($30 million), Ghana ($20 million) and in 2007 for Ethiopia ($30 million), Benin ($35 million) and Kenya ($80 million), and supplemental funding for Cape Verde ($5 million), Rwanda ($10 million) and Nigeria ($50 million), and a multi-donor trust fund grant for Sudan ($16 million). Repeater MAP projects are also under preparation in Malawi, Chad, and Burundi, and new HIV/AIDS projects are being prepared in Botswana, Cote D’Ivoire, Swaziland and Togo.
MAP performance has accelerated steadily, with over one billion dollars disbursed to date. Mobilization of civil society has been especially promising: the MAP has funded about 60,000 NGO, faith- and community-based subprojects, many at grassroots level. We also provide implementation and technical support, including to the IBRD countries in Africa that are not eligible for MAP funds (most of which have substantial grants from the Global Fund). A trust fund grant is supporting a broad capacity building effort in the Southern Africa Development Community.
Eastern Europe and Central Asia The Bank provides advice and analytical services, as well as loans and grants to support country-led responses to HIV/AIDS in the region, as envisaged in the 2003 Regional Support Strategy. Sub-regional studies were completed in South Eastern Europe (including Bulgaria, Croatia and Romania), Central Asia, Poland, and the Baltic States, and an assessment of national surveillance systems and HIV/AIDS interventions in prison systems in the region. Country-specific studies include the Georgia Country Study, analyses of the economic effects of AIDS in Russia and in the Ukraine, a study (with partners) on AIDS drug patents and registration systems in Russia, an impact assessment of the first Russian public education campaign, and an assessment of best practices in HIV harm reduction programs in the Russian Federation. Ongoing work includes benchmarking AIDS response in ECA countries; mapping and KAP studies in Uzbekistan, Kyrgyz Republic and Tajikistan; development of national HIV/AIDS accounts in the Russian Federation; a study of the links between the spread of HIV and transport routes; and an assessment of blood bank safety in Central Asia in partnership with the US CDC. Financial support includes a $60 million loan for TB and AIDS control in the Ukraine; a $150 million project in the Russian Federation to support TB and HIV control efforts; a $5.5 million IDA grant for the Moldova AIDS Control Project; and a grant of $25 million for a regional project in Central Asia that aims to minimize the human and economic impact of HIV in Kazakhstan, Kyrgyz Republic, Tajikistan and Uzbekistan. We co-sponsored a Business Summit on HIV/AIDS in Russia, and the First Eastern European and Central Asian Conference on HIV/AIDS, and supported public opinion surveys on HIV/AIDS in Albania and the Kyrgyz Republic that informed policy and program development. To strengthen health services capacity to deal with HIV, the Central Asia AIDS Project is supporting scaling up HIV Electronic Sentinel Surveillance in Kazakhstan, Kyrgyz Republic, Tajikistan and Uzbekistan in partnership with the US CDC. In 13 pilot sites, 6 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 with STI symptoms, and access to prevention programs. East Asia and the Pacific Fighting HIV and AIDS in the region has often been part of general health reforms. For example, Vietnam’s blood transfusion centers are supported by Bank financing ($38.2 million), and in Thailand the Social Investment Program supports HIV/AIDS work. The $104 million China Tuberculosis Project includes several HIV/AIDS sub-projects. China’s Health IX project ($60 million) includes components for HIV/AIDS and STI interventions and support, improved HIV/AIDS/STI surveillance, and improved blood transfusion services. In Vietnam, more than 60% of our US$35 million grant funding for HIV/AIDS is being transferred directly to 20 provinces/cities to develop and implement action programs in line with the National Strategy on HIV/AIDS Prevention. Policy guidance and analytical work contribute heavily in this region. For instance, an analysis of the likely benefits, costs and consequences of the Thai government’s decision to expand public provision of ART provided useful results for policy and program decisions that aim to achieve maximum treatment benefits, while promoting prevention and maintaining financial sustainability. Recent analytic work on key HIV policy issues is yielding useful results in China, Indonesia and Papua New Guinea. In China, the Bank is collaborating with Chinese experts and partners to develop analytic and advisory work on the economics of HIV/AIDS. The focus is on strengthening analytical, M&E and resource management capacity at the provincial level in two high-prevalence provinces. Similarly, several interrelated analytic pieces have enhanced understanding of Indonesia’s HIV epidemic and intervention priorities. This work includes i) prevalence and bio-behavioral surveys in Papua province, ii) cost-effectiveness of policies and programs to protect injecting drug users, and iii) addressing HIV transmission in prisons. A situation analysis of HIV/AIDS and other human development issues carried out with the government and donor partners in Papua New Guinea proposes strategic options, including for addressing HIV. South Asia In South Asia, the Bank has a multi sector regional team and action agenda, mainstreaming HIV in key sectors 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 in the region. This assistance has helped mobilize countries to improve and accelerate their response to HIV and AIDS, with encouraging trends in HIV infections in India. In India, Pakistan, Bangladesh, Bhutan, Sri Lanka and Afghanistan, we have committed a total of about $640 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 for a multi sector response. We support functional integration between HIV and reproductive health services, TB programs and other inter-related health problems and programs through regional support in the India national program and in most of our operations at different levels. We work closely with the Global Fund on several country operations – in Afghanistan, the funding for the national AIDS program operational plan is provided by the Bank and GFATM; in Nepal, the Bank is complementing GFATM funded activities, and India has one broad national plan of which all partners fund different aspects. Stigma and discrimination hamper HIV prevention efforts in the region. We have undertaken a major regional initiative (the Development Marketplace) to encourage, showcase and learn from innovative approaches to reducing stigma and discrimination across the region. From nearly 1,000 proposals, 75 finalists have been selected. Implementation of the winning 20-25 proposals will be monitored, and the DM will culminate in discussion and dissemination of results and lessons learned. Latin America and the Caribbean We support national and regional responses to a very diverse epidemic in Latin America and the Caribbean. Total lending for HIV of $425 million in Brazil and $235 in Argentina have helped fund national programs. Health sector projects in Mexico ($350 million), Venezuela ($30 million), Honduras ($27.1 million) and El Salvador ($142.6 million) also partly support HIV activities. Grants to Central America ($8 million) and Haiti (US$2.9 million) are helping prevent and control the spread of HIV. The Multi-Country HIV/AIDS Prevention (MAP) and Control Adaptable Program Lending for the Caribbean Region was approved in 2001 for $155 million and $113.15 million has been committed for nine Caribbean countries and for the regional Pan-Caribbean Partnership Against HIV/AIDS through the Caribbean Community (CARICOM). Analytic work has helped Mexico, Panama, Honduras and Argentina to assess the most cost-effective prevention strategies, assess behavior change communications in the region and options for scaling up the response in the Andean countries, and options for strengthening the transport sector’s response to HIV in the region. A joint multi-organization review (DFID, WHO/PAHO, the Global Fund to Fight AIDS, TB and Malaria, the UNAIDS Secretariat and the 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. We also assisted Guyana review all legislation pertaining to the health sector and to draft 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 Middle East and North Africa Building on a detailed report of the HIV situation in the region, we prepared a regional strategy and country briefs. The Bank financed the Djibouti AIDS Control Project (with an IDA grant of $12 million), is helping strengthen Lebanon’s surveillance capacity and national monitoring and evaluation system (through an IDF grant of $350,000); and supporting the Kingdom of Saudi Arabia in strengthening the National AIDS Program. At the regional level, under a joint Bank/UNAIDS proposal to the AIDS Strategy and Action Planning (ASAP) facility to strengthen National AIDS Strategies and Action Plans in MENA, support is being provided to Morocco and Lebanon, Algeria and Tunisia. Working with UNAIDS and WHO/EMRO, we are preparing 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 MENA region. The Global Fund to fight AIDS, Tuberculosis and Malaria (GFATM) The Global Fund to fight AIDS, Tuberculosis and Malaria is an independent partnership between public- and private-sector organizations. It works to increase global resources to fight these deadly diseases which cause nearly six million deaths a year. We were an active partner in setting up the Global Fund, serve on the Global Fund Board, and are working together to enhance coordination. Research and development for an HIV/AIDS vaccine We are involved in efforts to develop partnerships between public and private sector organizations to help find an AIDS vaccine for use in developing countries where the epidemic is most severe. We are a founding member of the International AIDS Vaccine Initiative (IAVI), a not-for-profit organization which has worked with academic scientists, biotech and pharmaceutical companies, and developing countries to put six new candidate vaccines into trials in 11 countries, including in East and Southern Africa and India. IAVI’s leadership in advocacy and public policy analysis has helped to expand the field, encouraging expanded funding of AIDS vaccine research by national governments and catalyzing the involvement of a range of private sector vaccine developers. We have contributed $8.86 million to the initiative through our Development Grant Facility.
- ### - Updated April 2008 Contacts:
Phil Hay, (202) 473-1796
Phay@worldbank.org |
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