1. Background
Although HIV prevalence is stabilizing and declining in some countries[1], Southern Africa remains the epicenter of the AIDS epidemic with 35% of new infections and 38% of AIDS deaths. Women account for 61 percent of those living with HIV and young women are three times more likely to be HIV positive than young men. The children of Africa represent 90 percent of the estimated 2 million children under the age of 15 living with HIV globally. Twelve million children in Africa under age 18 have lost one or both parents to AIDS. Treatment has now reached 2 million people, yet coverage is far from the 80% universal access goal. Given that new infections outpace those starting treatment — for every two people on treatment, another five are newly infected – prevention remains central to an effective AIDS response, particularly among groups at most risk (e.g. men who have sex with men, sex workers).

2. Key Issues in HIV/AIDS
Bank actions contributed to catalyzing unprecedented HIV/AIDS financing for Sub-Saharan Africa. Funding dramatically increased from 1.6 billion in 2001 to $13 billion in 2008 from domestic resources, The Global Fund to Fight AIDS, TB and Malaria (GFATM established in 2002), US President’s Emergency Plan for AIDS Relief (PEPFAR established in 2003), bilaterals and foundations. As a result, the Bank has become a technical and financial gap filler for national HIV/AIDS programs.

Despite the increase in AIDS funding over the past decade, financing gaps persist, an estimated $18 billion in 2007 for Africa, and the bulk of available funds is unpredictable and mainly covers treatment.  As new infections are on the rise in some countries, country and donor investments in prevention are not being sustained.  Clearly, balancing investments in treatment and prevention remain a challenge.

3. World Bank Programs – Africa Region Response
Since 2000, the Bank has provided $1.9 billion for HIV prevention, treatment, care and support in over 30 Sub-Saharan African countries and 5 regional programs.  FY09 HIV/AIDS commitments totaled $293 million – an increase from $64 million in FY08 – while the FY10 pipeline is projected at $76 million as of September 2009.  FY10-11 pipeline projects under preparation would support national HIV/AIDS programs in Malawi, Lesotho, Swaziland, Niger and Chad.

Since 2006, the Bank has supported 4.3 million persons aged 15 and older to receive HIV counseling, testing and their test results while 3 million pregnant women living with HIV received antenatal care during a visit from a health provider.  Furthermore, the Bank has also contributed to 50 to 70 percent of Sub Saharan African countries with observed improvements in behavior change of men and women aged 15 to 24.

Implementation of the Africa HIV/AIDS Agenda for Action (AFA), 2007-2011 has made considerable progress in: Accelerating implementation and closing funding gaps by responding to demands from hyper-epidemic middle income countries facing the economic crisis including assessing the fiscal implications of scaling up national AIDS programs in Botswana and South Africa and addressing groups at most risk to HIV; Supporting long term sustainable strategies and strengthening national systems including improved strategic planning, institutional effectiveness, integration with health systems to address TB/HIV co-infection and linkages with reproductive health and nutrition, governance and social accountability, supply chain management, HIV/AIDS impact evaluation, and monitoring and evaluation; Contributing to knowledge generation and learning through building capacity and promoting cross-country knowledge sharing; and Improving donor coordination through joint annual planning and support to the Three Ones.

4. Partnerships
As one of 10 UNAIDS cosponsors, the Bank has been designated the lead organization in providing support to strategic, prioritized and costed national plans; financial management; human resources; supply chain management; capacity and infrastructure development; impact alleviation and analytical work. Funds from the UNAIDS Unified Budget and Workplan supplement IDA and IBRD investments to enable the Bank to play this role.   The Bank is moving forward on its UN designated role to ‘Make the Money Work’ by strengthening partnerships with donors and other stakeholders including civil society.  Joint collaboration between UNAIDS, WHO and the Bank is working to quantify the impact of the economic crisis on HIV/AIDS treatment and prevention programs at the country-level and define how partners can best help countries minimize negative impact.

5. Next Steps
The Bank’s investments in HIV/AIDS in Africa face challenges in: Mitigating the negative impact of the financial crisis on scaling up access to HIV/AIDS treatment and sustaining investments in prevention efforts and strengthening weak national systems (fiduciary, M&E and health) and civil society capacity.

[1] E.g. Malawi, Namibia, Rwanda