Sub-Saharan Africa: Since 2000, the Bank has provided more than $2 billion for HIV prevention, treatment, care, and support in more than 30 countries in Sub-Saharan Africa and five regional programs. In fiscal year 2009 (FY09) commitments totaled $293 million, up from $64 million in FY08. This included new stand-alone AIDS projects in Nigeria ($225 million) and Botswana ($50 million), as well as additional financing of ongoing projects in Mali and the Republic of Congo. As of July 2011, the Bank’s active HIV/AIDS portfolio in Africa comprises 19 projects, totaling $900 million in commitments with $675 million disbursed in FY11 alone. Several other health systems strengthening projects are working to address the HIV/AIDS response, for example in Cameroon, the Democratic Republic of Congo, Kenya, Mozambique, and Uganda.  In addition, an estimated $280 million in active commitments are being directed toward HIV/AIDS prevention activities through operations in agriculture and rural development, education, finance and private sector, social protection, urban development, and economic policy (e.g. Poverty Reduction Support Credits). Fiscal year 2011 (FY11) lending totaled $95 million and will support national HIV/AIDS programs and health systems in Kenya ($55 million), Niger ($20 million), and Swaziland ($20 million). The Bank will also support the HIV/AIDS program in Mozambique through the recently approved Health Commodity Security project ($39 million). FY12 projections total $80 million, with projects under preparation in Malawi ($50 million) and additional financing in Burkina Faso ($30 million).

East Asia and the Pacific: In the region’s diverse and developing environment, the needs for support for HIV/AIDS have shifted due to lack of financial sustainability of HIV programs, changing epidemiological profile, and competing disease priorities. In response to these challenges, the Bank, with regional partners, has assisted governments in strengthening their HIV portfolios by focusing on allocative efficiencies and improving effectiveness. In Indonesia and Vietnam, public expenditure tracking surveys to promote efficient resource management and allocation have been completed. In China, Indonesia, Malaysia, Papua New Guinea, and Thailand, allocation of available AIDS resources is being improved. In Thailand and Vietnam, ongoing impact evaluations will help improve program effectiveness. 

Eastern Europe and Central Asia: Despite gains by the Bank and other partners in the region, new HIV infections are rising. Between 2003 and 2008, an HIV and tuberculosis control project in the Russian Federation more than doubled the number of patients receiving treatment. Expanded access to treatment led to a drop in HIV-positive infants born to HIV-infected mothers, from 13.2 percent in 2003 to 10.6 percent in 2008, and treatment coverage of tuberculosis patients rose 95 percent.  However, despite gains, HIV incidence increased 25 percent between 2001 and 2009 in five countries. A $26.9 million grant supports the Central Asia AIDS Control Project, addressing the epidemic by strengthening health systems. To address systemic issues, the Bank is investing in policy dialogue and sharing operational lessons critical for HIV prevention.

Latin America and the Caribbean: In response to the diversity of the epidemic in the region, the Bank has embarked on a multi-sector approach to address HIV/AIDS, targeting most at-risk populations. Total Bank lending in the region was $708.8 million with HIV/AIDS projects in Brazil, Central America, and the Caribbean. Five projects in the Caribbean and Central America regions were completed last year and three projects in Barbados, Brazil, and Jamaica ($210 million) are ongoing. The Bank’s support to AIDS is increasingly focused on impact evaluation and strategy development. The Bank is also conducting an assessment on lessons learned from implementing HIV/AIDS projects in the region since 1994 and fostering opportunities for South-South knowledge exchange across the region. HIV treatment coverage has increased from 10 percent in 2004 to 51 percent in 2008, higher than the global average of 41 percent for low- and middle-income countries. Due to increased provision of Prevention of Mother to Child Transmission services, the proportion of pregnant women who are tested reached more than 90 percent in most countries. More than 60 percent of countries in the Caribbean reported that more than 85 percent of people living with HIV are alive after 12 months on antiretrovirals.

Middle East and North Africa: In FY10, total Bank financing for HIV/AIDS in the region totaled $17 million. The Djibouti AIDS Control Project ($12 million grant) was completed this year, and the Bank support for HIV/AIDS continues through an ongoing health project. The Bank also supported Lebanon’s surveillance capacity and national monitoring and evaluation system (through a $350,000 grant) and is helping it update its national AIDS plan. The Bank is helping strengthen national AIDS strategies and action plans in Algeria, Egypt, Lebanon, Morocco, Saudi Arabia, Syria, and Tunisia. In collaboration with partners, the Bank prepared and published a regional synthesis study and policy note both in Arabic and English that yielded groundbreaking data on the epidemiology and epidemic potential in vulnerable groups in the region.

South Asia: Given this region’s low HIV prevalence but concentrated epidemics among vulnerable populations, the Bank has adopted a multi-sector approach focusing on the drivers of HIV—unsafe sex and injecting drug use—and works closely with governments and civil society. In Afghanistan, Bangladesh, Bhutan, India, Nepal, Pakistan, and Sri Lanka the Bank has committed $670 million in credits and grants to strengthen national programs. Bank projects support surveillance, monitoring and evaluation, targeted interventions for high-risk population groups, blood safety, stigma-reduction efforts, and strengthening public and private institutions. The Bank supports convergence of treatment for AIDS with other health services, integration of HIV and reproductive health services, tuberculosis and other health programs.

For more information, visit the Bank’s HIV/AIDS website: www.worldbank.org/aids.