“By acting now and mobilizing greater political commitment at the country level, governments and development partners could stave off major crises that would damage health as well as economic growth, the labor force and the welfare of households,” said Shigeo Katsu, Vice President for the Europe and Central Asia Region (ECA).

The new report describes the scope of the epidemic, and examines the different constraints that currently impede success in fighting HIV/AIDS in the region.  It then presents the Bank’s approach to the problem in the region.

The cost of inaction

An uncontrolled HIV/AIDS epidemic could have devastating consequences on health and development in ECA, the report warns. If the HIV epidemic becomes widespread among the working age groups in the region, annual economic growth rates could decline by 0.5 to 1.0 percent.  The effects of this drop will be compounded by rising health expenditures, which could increase by 1-3 percent, with substantial impacts on the health budgets of poorer  countries in the region.  Furthermore, the dependency ratio (the ratio of non-economically active to economically active people) could rise, which would severely strain social protection systems.

Knowledge and prevention matter, as does sustainable care of good quality

“Countries are paying more attention to the problem, but most of the current efforts to curb HIV/AIDS in the region are too small to have an effect on the course of the epidemic,” notes Olusoji Adeyi, Lead Health Specialist in the ECA Region of the World Bank and lead author of the Regional Strategy. “Large-scale programs for HIV/AIDS prevention and care will require that funding from all sources increase from about $300 million in 2001 to about $1.5 billion by 2007.  But money alone is not the issue.  It is crucial to improve the local information base for programs, to support what works against HIV/AIDS, and to break down the barriers to effective actions in the region.” 

The regional strategy of the World Bank pledges to support greater political and social commitment to fighting the epidemics of HIV/AIDS and Tuberculosis in the region.  It stresses the need to generate and use essential information in the program design, implementation and evaluation, including: epidemiological and behavioral surveillance as the basis for effective prevention; estimations of the economic and social impacts of HIV/AIDS and TB; how to get the best value for money and estimates of resource requirements for prevention and treatment.

The report pays particular attention to the prevention of HIV infection.  Key factors in prevention include blood safety, harm reduction among injecting drug users, programs to prevent HIV transmission among sex workers and their clients, as well as interventions among prison inmates and ex-inmates, who are among the hardest-hit in the region.  The authors call for ensuring sustainable, good-quality care for those infected with HIV, and the control of a dual tuberculosis-HIV epidemic.  The Bank will support country-led preparations and implementation of large-scale programs to curb HIV/AIDS and tuberculosis.

The World Bank’s support

The World Bank is already active in the fight against HIV/AIDS in Eastern Europe and Central Asia, on several fronts: through strategic advocacy, subregional and country specific studies on the extent of the epidemic, as well as through grants and loans for HIV/AIDS control.

The organization works as part of a global coalition against HIV/AIDS, that brings together UN agencies, the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), governments, NGOs, bilateral organizations, and multilateral agencies in support of country- and regional-level responses to HIV/AIDS

“This document reflects our contribution to a larger effort that is supported by many partner agencies in the Region,” concludes Debrework Zewdie, Director of the Bank’s Global HIV/AIDS Program.   “Knowledge of the dynamics of the HIV/AIDS epidemic in Eastern Europe and Central Asia will continue to increase. That growing knowledge base will be useful in tackling the epidemic. The Bank’s Regional Support Strategy will be updated as more is learned about the epidemic and how to respond to it.”

Useful links: For more on HIV/AIDS in Europe and Central Asia, click here.  

The predominant role of injecting drug users is what distinguishes this epidemic from that of most other regions.

The epidemic is mainly affecting young people. More than half of those who tested positive for HIV/AIDS are between 20 and 30 years of age.

"Countries are paying more attention to the problem, but most of the current efforts to curb HIV/AIDS in the region are too small to have an effect on the
course of the epidemic," warns World Bank Lead Health Specialist in the Eastern and Central Asia Region Olusoji Adeyi.

"Knowledge of the dynamics of the HIV/AIDS epidemic in Eastern Europe and
Central Asia will continue to increase," says World Bank HIV/AIDS Program
Director Debrework Zewdie