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World AIDS Day: STOP AIDS, Keeping the Promise, Investing in the Future

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  • Bank marks World AIDS Day 2009 with an institutional commitment to stay the course in confronting HIV/AIDS epidemic
  • Bank support to countries focuses on better understanding epidemic trends; where and how new infections are occurring
  • Bank holds a high-level panel discussion with health, development leaders on the topic of “Keeping the Promise, Investing in the Future”

December 1, 2009 —With the latest HIV/AIDS figures from the UN showing a gratifying downwards trend in new infections, the Bank marks World AIDS Day 2009 today with an institutional commitment to stay the course in confronting what remains one of the most stubborn development problems of our times.

The new UNAIDS “Epidemic Update” released last week documents continued steady progress. New HIV infections have fallen steadily by 17% since 2001, and annual deaths from AIDS – although still a devastating 2 million, are also falling from previous years. More research and better data have improved our understanding of HIV and the marked differences in HIV epidemics across regions and countries and even within countries and cities. In Bangladesh, for example, long-standing prevention efforts focused on sex workers, injecting drug user, men who have sex with men and other groups at highest risk have helped contain HIV– except among injecting drug users in one neighborhood of Dhaka. (A new report will be launched in a few days.)

To quote Michel Sidebe, UNAIDS Executive Director, there is cause for “hope and concern”. Hope because four million people in low- and middle income countries are on ART, concern that five million more people need treatment today. Hope because new infections continue to fall each year, concern that still 2.7 million people were newly infected in 2008, and prevention progress is uneven and inadequate. Hope that coverage of services to prevent mother-to-child-transmission rose from 10% in 2004 to 45%, concern that this is still very far from universal coverage.

Providing treatment to four million people in low- and middle income countries – including in some of the world’s poorest states, with hard-pressed health systems – is a remarkable public health achievement. For example, Botswana’s anti-retroviral drug program covers 80% of its population and has cut AIDS-related deaths by more than half in five years. But in all nine countries in Southern and Eastern Africa, where more than 10% of the entire population aged 15-49 years have HIV, the challenge remains daunting.

AIDS Events at the Bank

Leaders of global agencies such the Global Fund, PEPFAR, and Deputy US Secretary of State, Jack Lew, will join Bank Managing Director, Ngozi Okonjo-Iweala, and other noted external guests and Bank staff to raise awareness of the continuing threat to people’s lives posed by HIV which was first clinically identified 28 years ago in 1981.

The first event in the Bank’s World AIDS Day program was in Delhi last week when it hosted the public screening of two new films about HIV. A capacity crowd watched two new films about HIV. Noted film-maker Sai Paranjpye was one of the 26 grant winners in the South Asia Development Marketplace for innovative proposals to reduce AIDS-related stigma and discrimination. In making “Suee” (the Needle”) Ms Paranjpye worked with injecting drug users, social activists and experts on “harm reduction”—preventing HIV transmission through sharing needles and syringes. The film will be shown on public TV in India on December 1st. The second film shows how sexual behaviors to relieve lonely nights away from home can put truck drivers—and their wives – at risk of HIV. Mariam Claeson, AIDS coordinator for SAR noted that “The team of seven truckers/actors watching “live” at the screening got a big round of applause.”

On Tuesday mid-morning, more than 400 people will attend a high-level event and panel discussion with health and development leaders and others on the topic of “Keeping the Promise, Investing in the Future”. US Deputy Secretary of State, the Hon. Jack Lew will talk after opening comments by President Zoellick, MD Ngozi Okonjo-Iweala, and Beldina Otieno. Beldina, a teacher in Kenya and one of 33 million people living with HIV, tells her inspiring story in the prize-winning documentary “Courage and Hope”.

Also speaking is Dr Jean (Bill) Pape, Director of a network of clinics providing free treatment to half a million people each year in Haiti. A study tracking health outcomes of people on antiretroviral treatment (ART) in Haiti found that 40% went hungry – sometimes going all day without any food during the food crisis that sparked riots in Haiti. Their risk of dying increased 36% compared to the 20% who had enough to eat – ART cannot be taken on an empty stomach. This is vivid clinical evidence on how poverty and hunger can undermine the gains in life and health that the enormous global investment in treatment has achieved.

Entrenched social norms and behaviors are changing far too slowly. Very high proportions of the population report more than one sexual partner, and condom use remains too low. In countries with very high prevalence, the many couples in which one person has HIV means that even people in stable relationships with no other partners may be at high risk. There is too little investment in “positive prevention” to reach people with HIV.

The changing HIV epidemic patterns and shifts in new infections make it absolutely vital to use the growing data and information to focus and target prevention. This is a strong focus of Bank support to countries. Often working with UNAIDS and other partners, teams have compiled and analyzed all relevant existing data in 96 countries, to better understand epidemic trends and where and how most new infections are occurring.

Comparing the epidemic picture with existing prevention efforts and global and local evidence on what works reveals prevention gaps, mismatches and strengthens. The evidence-based suggestions for better targeting and focusing prevention then inform the advice and support provided through ASAP – the Bank-hosted team that supports countries to develop AIDS strategies and plans that “follow the evidence”.

According to Debrework Zewdie, the outgoing Director of the Bank’s Global AIDS Program who takes over as Deputy Executive Director of the Geneva-based Global Fund at the start of January, the Bank must continue to play a strong role in helping countries provide effective prevention, care, and treatment services for their communities.

“The Bank stepped up boldly with the first billion dollars for HIV a decade ago when denial and inaction were widespread. Now, the tide of the epidemic finally seems to be turning. But we are still in very deep water. Especially with much of the world still grappling with the food and financial crises, the Bank is doing the right thing in reaffirming to countries, just as each Bank president has done since 2000, that we will continue to support effective efforts to prevent and cope with HIV for as long as it takes to succeed against this virus.”

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