HIV/AIDS remains a major development, health and security challenge, particularly in Southern Africa, where hyperepidemics continue to rage. Adult HIV prevalence in South Africa (the country with the most cases) and elsewhere is either stable or has started to decline. Global funding for HIV/AIDS programs increased to US$8.9 billion in 2007, but significant funding and programmatic gaps remain. 1.34 million[2] people in Africa now use antiretroviral therapy, but this represents only 28% of people who need it-80% coverage is the universal access goal agreed by all donors and countries. Scale-up has been especially successful inBotswana, Kenya, Malawi, Namibia, Rwanda, South Africa, Uganda and Zambia.
There is evidence of a shift towards safer behavior, particularly among young people, in countries such as Malawi, Kenya, Zimbabwe, Togo, Tanzania, Rwanda and Zambia. Decreased numbers of young people reporting sex with non-regular partners in the previous year, increasing numbers of young people report that they used condoms the last time they had sex with a non-regular partner, as well as declines in HIV prevalence among young pregnant women in urban and/or rural areas in some countries, are encouraging signs that reflect the impact of ongoing prevention efforts.
Women bear a disproportionate part of the AIDS burden. In Africa, young women (ages 15-24) are two to six times more likely to be HIV-infected than young men. Lack of political will, limited capacity, weak institutions and restricted funding make mitigation of gender inequalities a major challenge. The world needs to scale up existing tools and methods, provide new prevention tools for women, and conduct more in-depth analytical work on which to base decision making, training, and integration.
Human resource shortages hamper program implementation, documentation and systems adjustments.
Table 2: Africa Regional HIV Portfolio (2001 to March 2008)
Country Projects
42 approved, including 7 repeater projects ($267million), in 33 Sub-Saharan African countries
Sub-regional projects
5 approved (US$122 million), 1 under preparation
Total commitments
$1.5 billion (US$256 million in FY07 alone)
Total disbursements
$1.06 billion
2nd generation HIV/AIDS projects approved
Benin, Burkina Faso, Ethiopia, Eritrea, Ghana, Kenya and Madagascar
Projects under preparation
Botswana, Burundi, Cameroon, Chad, Cote d'Ivoire, Lesotho, Malawi, Mozambique, Nigeria, Swaziland, Togo and HIV/AIDS Southern Africa Regional Transport Corridor
Recognizing the implementation bottlenecks and the development of a regional HIV/AIDS results Scorecard, eight projects were restructured to align the project development objectives to national strategy and to the Scorecard. The Scorecard is linked to the Africa region Results Monitoring System (ARMS).
In partnership with UNAIDS, ACTafrica launched specialized Technical Support Teams (TST) to support national programs facing implementation bottlenecks. TST conducts in-depth reviews of the national AIDS program, identify existing bottlenecks and recommend pragmatic actions to improve performance. This support has been provided to Senegal, Niger and Madagascar. Burkina Faso is planned for November.
With UNAIDS financing, AIDS Strategy and Action Planning (ASAP) support was provided to 18 countries (and two civil society organizations and one regional project). The support included review, technical support, planning, costing, and capacity development for more evidence based national programming.
Six MAPs closed in FY07 after disbursing over $230 million collectively: Benin, Burkina Faso, Cameroon, Ethiopia, Gambia and Uganda.
The Bank is working with other key players to identify mechanisms to address the hyper-epidemics in Southern Africa and address the regional issues fueling the epidemic, including preparation of a new project in Botswana using a buy-down from the European Union. The Bank is developing a Southern Africa Regional Transport Corridor HIV/AIDS project to address vulnerable groups along the transport corridors of Malawi-Mozambique, South Africa-Zimbabwe, and reach the epicenter of the epidemic in the hardest hit middle-income countries in the region.
Regional project for the Horn of Africa: the US$15 million IGAD[3]
Regional HIV/AIDS Partnership Program (IRAPP) Support Project was approved in June (the first approved under the Africa Catalytic Growth Fund), became effective in September, and will be launched in December 2007 in Uganda. IRAPP is dedicated exclusively to combating HIV/AIDS among cross-border and mobile populations and IDPs in the Horn of Africa - adding value to national efforts.
Disease Integration: The Africa region has scaled up its efforts to address TB-HIV integration in nine high-burden TB countries, and established a regional TB team covering both technical and operations areas. Detailed situation analyses of four countries have been completed, and plans finalized to conduct specialized studies in the areas of HIV/TB drug resistance and country capacity development. The Bank is also working with other partners on integration of HIV and Reproductive Health, and Maternal and Child Health programs.
The Regional HIV/AIDS Treatment Acceleration Program (TAP) project was extendedin September in preparation for project restructuring in October 2007 to incorporate greater focus on learning lessons from country experiences and research on the benefits, risks, risk mitigation and management modalities for scaling up antiretroviral treatment in Africa.
Africa Region HIV/AIDS Agenda for Action 2007-2011 (AFA)
The Africa Region's "HIV/AIDS Agenda for Action 2007-2011" is the culmination of a year long consultation and analytical process. The AFA positions the Bank for the next phase of the African response, given the many changes that have taken place globally in the HIV/AIDS arena since 2000. The Board will hold a Technical Discussion on the AFA in early November 2007. The strategic objectives of AFA include:
Bank sectors are increasingly incorporating HIV/AIDS components into their sectoral lending operations. As of end-FY07, 33 active projects have HIV/AIDS components worth $300 million in commitments. Over the five-year AFA period, the region will scale up mainstreaming HIV/AIDS in Agriculture, Social Development, Rural Development, Transport, Education, Mining, Urban Development and the Private Sector.
ACTafrica will focus its future analytical and operational assistance on the key strategic challenges facing HIV responses, including a US$444,000 proposal for gender mainstreaming in HIV operations and effective capacity development of Bank staff, national AIDS commissions, and civil society in key program areas.
Improving governance in HIV/AIDS programs. In collaboration with the Tanzania Government, WBI and GHAP, ACTafrica cosponsored a Capacity Enhancement Program in the HIV/AIDS response at the district and community levels in Tanzania in October. Assessments are planned for FY08 in select countries to examine governance issues in community responses.
ACTafrica will host a learning event on "Targeting Vulnerable Groups in HIV/AIDS Activities in Sub-Saharan Africa" for anglophone countries in January 2008, following a similar francophone workshop held in May 2006. The objective will be to ensure sustainability by incorporating the experiences, needs and interests of anglophone countries in the design, implementation and monitoring of interventions targeting vulnerable groups such as commercial sex workers, long-distance truck drivers, refugees, women, youth, prisoners, and men who have sex with men (MSM).
Guidelines for Improved Implementation
Working with respective UN agencies and other teams, ACTafrica has developed guidelines to assist countries, donors and technical entities on key implementation areas:
Assessments on HIV/AIDS and demobilization and reintegration of ex-combatants conductedin Angola, Burundi, Congo-Brazzaville and Rwanda on HIV/AIDS activities implemented by demobilization programs with collaboration with Banks Demobilization and Reintegration team (MDRP).
An HIV/AIDS Results Scorecard was developed with relevant Bank units and UNAIDS, which will apply to all ongoing and future HIV/AIDSoperations in the Region. The Scorecard will reduce country burden on multiple reporting per the Paris Declaration recommendations; contribute to M&E harmonization at country level; and provide a better tool to report on the response to the epidemic.
"A Synthesis of International Guidance for HIV/AIDS, Nutrition and Food Security" was developedby the World Bank, WFP, WHO, UNAIDS and bilateral experts. The Bank and its partners are assisting Mozambique and the Republic of the Congo to review their national HIV, nutrition and food security programs to make them more effective.
Analytical work resulting in the "HIV/AIDS and the Prison Community: Opportunities for Action" document will serve as a basis for a technical meeting in Mombasa in November 2007 with the World Bank, UNODC and UNAIDS.
The Bank is working with PEPFAR/OGAC in planning for the Implementers Meeting which reviews successes, lessons learned and challenges identified during implementation of programs supported by the three main donors (PEPFAR, Global Fund and World Bank). The first regional meeting was held in Rwanda in June 2007 and the second one is scheduled to be held in Uganda in June 2008.
Stronger partnership has been developed with WHO in addressing TB/HIV integrated responses at the country level. With support from the Dutch Government, an assessment and capacity development program has been launched.
ACTafrica will host several events to commemorate World AIDS Day 2007 and highlight the Region's support to national HIV/AIDS programs.
ACTafrica has planned key stakeholder consultations to jumpstart the five year Agenda for Action. These consultations include: (a) Private Sector Partnership in scaling up national AIDS responses in December 2007 in Mali; (b) Stakeholder consultation with global and sectoral trade unions in December 2007 in South Africa; (c) capacity development workshop on vulnerable groups in January 10-13, ‘08 in South Africa; (d) TB/HIV integration capacity development workshop in March 2008, and (e) Consultation on HIV strategic planning and gender mainstreaming for key stakeholders in April 2008 in Madagascar.
[1] 2007 AIDS epidemic update, UNAIDS December 2007 edition(all prevalence figures quoted are from this report).
RSS