Press Conference on AIDS Activities

Washington, DC, November 28, 2000

PROCEEDINGS

MS. ANSTEY: Welcome to this background briefing in the run-up to World AIDS Day, which as I think everybody knows, is on Friday, December 1st.

We will actually be following this press conference with a showing of the MTV documentary, "Staying Alive," which is a 30-minute documentary the Bank sponsored with MTV and with UNAIDS, which is going to be shown on Friday to about 800 million households around the world on MTV and on a number of other channels. MTV has offered it free to worldwide broadcasters.

On the panel here with me, I have on my left Debrework Zewdie, who is the lead AIDS coordinator for the World Bank, and she will be telling you about the situation, the global "state of the union," so to speak, on AIDS and the work of the Bank.

To her left is Jacob Gayle, who is the UNAIDS liaison representative who has been working with the Bank for the last year, and he can also tell you about the work of UNAIDS.

As many of you know, over the last couple of years, the World Bank has stepped up all of its work on AIDS. We are also having a photo exhibit, photographs by Andrew Patkun [phonetic], which is up now in the Atrium, and we would invite you all to go and look at some of those photographs which really look at the lives of people suffering from AIDS, AIDS orphans, in Africa.

And for the first time in Bank history, we have been the first to put a banner on our own building rather than have others do it for us. There will be a 30-foot AIDS ribbon on the building I think up by tonight, with the address of the web site. We are intending on Friday to black out our web site for World AIDS Day and just have the AIDS logo, and you will go straight to the AIDS information.

So let me, without saying any more, hand it over to Debrework, who will run you through the situation on AIDS globally now.

MS. ZEWDIE: Thank you, Caroline.

What I will do will be to go through the global numbers. As you know, the United AIDS Program, UNAIDS, comes up in collaboration with the World Health Organization with new numbers every year on World AIDS Day. I will go through those numbers very briefly. Then I will touch upon what the Bank is doing, and finally, we will have a discussion, hopefully, on all the subjects.

[Slide.]

As you can see from the slide in front of you, now we have 36.1 million people who are living with HIV/AIDS. The new infections, which seem to grow every year, are 5.3 million now, and we have over 3 million deaths. The cumulative AIDS deaths are about 22 million, and people who have been infected by this virus from the beginning of the epidemic total 57 million people.

[Slide.]

On the next slide, you will see the trend in the different continents. There are signs of stabilization-- I am fearful when I use the word "stabilization" vis-a-vis the epidemic in Africa--of new infections in a number of African countries.

You do remember that most of the countries had reached as high as 35 percent, and I think it is the law of nature that it cannot go any further than that but stabilize. I want you to keep that in mind.

South and Southeast Asia, the progress in this part of the world is very impressive indeed, and at least this year, the focus is not on South and Southeast Asia; it is rather in Eastern Europe, where the epidemic literally has exploded in Russia. In 1987, there were only 29,000 people infected with this disease, and by the year 1999 alone, over 50 million infections have been reported. In Eastern Europe, the same thing. There are 700 infections now, and a year ago, this was only 420. So these are the two regions that need to be highlighted this year.

Latin America and the Caribbean, from the beginning of the epidemic, we have seen a mosaic in this part of the world, where you have low and high prevalences.

North Africa and the Middle East, we still continue to have limited data in this region; however, for the first time, antenatal clinic studies from Algeria show a rise in the epidemic of about one percent in the studies that have been done.

Next slide.

[Slide.]

This is something which should put the entire HIV/AIDS epidemic in perspective. If you look at the Ukraine, for example, this slide was done a year ago, and I just mentioned to you what is happening in Eastern Europe and Russia. These are trends which we have seen over and over again in all parts of the world.

[Slide.]

And when you look at the next slide, these countries that you see in Sub-Saharan Africa now used to look like the slide you saw earlier. The epidemic in the 1980s, for example, in Ethiopia, used to be 1 to 2 percent in the general population; it is over 10 percent now. So the trend has consistently shown a rise in most of the countries except in a few countries that are still being mentioned, Senegal and Thailand particularly, who have had a handle on this epidemic. Uganda started showing a stabilization after the epidemic had gone out of proportion.

[Slide.]

Still, Africa harbors the largest number of AIDS orphans in the world. As you can see, the number of global orphans in 1999 was 13.2 million, and 12.1 million are in the Africa Region, which is a tremendous concern to all of us.

Next slide.

[Slide.]

So HIV/AIDS continues to drive a problem which goes in a vicious circle. There is vulnerability, there is spread, there is poverty, and kids in most parts of the developing world are taken out of school. That leads them into risky behaviors; development comes down; and then, you can see the fall in education, inequity, and the spread of disease increases.

What is the Bank doing in all this? I will very briefly touch upon the work that we do at the Bank, and this is not a comprehensive list.

[Slide.]

We have big programs in India, Brazil, and Russia. These are programs which go through the whole spectrum of prevention, care and treatment.

[Slide.]

We have two regional projects which are new and which we have done since World AIDS Day last year.

[Slide.]

The first one is the Caribbean, where we are planning to have a project in the range of $85 to $100 million for the countries in the Caribbean who are ready to fight the HIV/AIDS epidemic. This was done in very close consultation with the Caribbean community, CARICOM, and this would be a four- to five-year loan for these countries. We expect a synergistic effect by having all the countries in the Caribbean participating in this project.

[Slide.]

As we have communicated to most of you, we have what is known as a Multi-Country HIV/AIDS Program for Africa. Starting from our Spring Meeting last year, the President of the Bank has focused on expanding the HIV/AIDS work within the Bank, and we have a $500 million project for Sub-Saharan Africa alone.

The objective of this project is dual. One, we do not go to countries and write projects. We fund their national AIDS control programs. From the beginning of the epidemic, most countries have never had adequate funding to implement their national strategies. It would be done in a multisectoral manner, because the focus on health alone has not given the result that the world expected.

[Slide.]

The emphasis would be on youth, especially on youth and women of childbearing age. We started with two countries, Ethiopia and Kenya. As I speak now, we have these countries that you see in front of you, who have applied for the loan and whom we have been working with very closely. The intention is to use up this $500 million during this fiscal year. Already, the sum for all of these countries comes to $515 million, and the Board is ready to replenish the money as soon as we use it up. So this fiscal year, we will be working in these countries.

Before I go further, before we initiated the MAP Project, there were only one or two projects in the Africa Region that were in the pipeline for HIV/AIDS work, so this is a dramatic change from where we started a year ago.

Next slide, please.

[Slide.]

Next fiscal year, we will be covering these countries. Our hope by the end of this is to cover all of Sub-Saharan Africa so that countries will have enough funding to implement their national HIV/AIDS control programs.

Next slide.

[Slide.]

These are the operational works that we do within the Bank. Apart from these, we are part and parcel of two big initiatives in the world. One is the international vaccine initiative, where we play a major role. The second one is the dialogue between the pharmaceutical companies and the UNAIDS partners, namely, the UNAIDS Secretariat, the World Health Organization, UNICEF, and the World Bank. So these are two of the issues that we have been engaged in apart from the operations work that we have been working on.

Finally, there is what is known as the Africa Development Forum. This is the Economic Commission for Africa that started a forum last year. It was on communications last year. This year, it is HIV/AIDS, the major leadership challenge to Africa. The Secretary-General of the U.S. will be present next week in Addis, heads of state, prime ministers, and community and religious leaders will be present in Addis to move the HIV/AIDS issue at a very different level as far as Africa is concerned. You have heard about the photo exhibition which will be up in the Atrium.

I'll stop here. Thank you, Caroline.

MS. ANSTEY: Can we open the floor to questions? I think we have some mikes around the room.

Yes, the gentleman in the third row.

QUESTION: Yes. Going back to the Caribbean, could you be more precise on the countries, because you were talking about as a whole, but I was wondering if you could give us an overview, country by country.

MS. ANSTEY: Let's take a couple questions, and then we'll handle them.

Yes, in the back.

QUESTION: About Latin America and the Caribbean, you said that there is a mosaic of patterns of transmission. Would that exactly mean in terms of patterns of transmission are different by country, which is the regional situation in that sense?

You mentioned a special country program in Brazil. Has Brazil some special influence on the data or on the situation on AIDS in South America that can affect the other countries?

MS. ANSTEY: Yes?

QUESTION: I am hoping you will be able to elaborate on some of the reasons for the explosion in the infection rates in Eastern Europe and Russia.

MS. ANSTEY: Okay. Debrework?

MS. ZEWDIE: Incidentally, within the room are a number of my colleagues, who could answer the questions. Martha has been doing HIV/AIDS economic work in the Bank for a long time. Keith Hanson is from the AIDS Campaign Team in Africa.

We did invite the task team leaders of the Caribbean and the other countries, and hopefully, they will be here.

Let me give the question on the Caribbean to Jacob Gayle, who resides in the Bank as a secondee from UNAIDS and who is also participating in the Caribbean project. After he answers that, I will answer the two questions that came up.

MR. GAYLE: Thank you. Good morning.

Just very quickly to mention that the Caribbean community, CARICOM, through its Secretariat, has worked together with not only the member countries of CARICOM but also the non-CARICOM countries of Cuba, Dominican Republic, and Haiti to put together a Caribbean regional strategy for the response to HIV/AIDS. It is that strategy that has led the way for the World Bank to work together with the entire Caribbean community.

Outside of Puerto Rico, the Caribbean countries that are hardest hit, of course, are located in Hispaniola, which would be Haiti and Dominican Republic. We also recognize the major impact that HIV has had within the Bahamas. And very clearly, although we don't have fully accurate statistics in Guyana, we see very clearly from surveillance reports that Guyana's epidemic has skyrocketed over the past three years.

All of these countries have been involved with developing the regional strategy from which the World Bank's efforts come. Countries that are already eligible for World Bank funds, of course, are going to be those countries that are going to be directly related to this initiative. However, this is linked to bilateral efforts to support the gaps where non-World Bank countries are involved. So we recognize in a region as small as the Caribbean that there is no way you can deal with only Haiti or Dominican Republic; Jamaica is quite involved; Barbados is taking quite a leadership role for the region. But it is going to be a mixture of resources--World Bank loans, bilateral grants, and of course, country-directed, country-national budgets and efforts as well.

MS. ZEWDIE: The two questions--I think Jacob addressed part of the reason for the mosaic epidemic. If you take Haiti and Brazil, for example, these show you the two extremes of the HIV/AIDS epidemic. The epidemic in the Caribbean in countries like Haiti and the Dominican Republic look more like Sub-Saharan Africa epidemics. Then, you have countries where the prevalence rate is very low. So that is why the Latin America epidemic has always been described as a mosaic. It has very high-prevalence countries, medium-prevalence countries, and low-prevalence countries.

Brazil is one of the best stories in Latin America. They have not only dealt with prevention and care effectively. Now they are one of the first countries to put treatment in place, and that has helped their prevention and care activities. Another thing that stands out in Brazil is the way they have utilized at least the Bank loan with almost 60 percent of it going to nongovernmental organizations and having a good implementation record.

Why is the epidemic exploding in Eastern Europe? The major transmission route for HIV/AIDS in Eastern Europe is injection drug use. More men than women are affected through this, and the epidemic is spreading into the general population because the men bring it to the women.

There was also tremendous denial within Eastern Europe, especially on the part of governments, to accept that this is an epidemic which would explode. The world knew that the HIV/AIDS epidemic in Eastern Europe was going to explode two years ago, three years ago, and what we see now, this jump from 400,000 to 700,000, is the result of inaction. So that by and large, it is injection drug use and drug-trafficking in that part of the region.

QUESTION (Mark Egan, Reuters): You said that you have committed about a billion dollars so far. How much was it before? Was it half that last year--is that correct--and how much is it going to be? And then, a couple of other questions. Do you also lend to countries that the World Bank normally does not lend to for AIDS projects; and how is the money used--like what sorts of day-to-day things do countries do--is it needle exchange programs, is it condoms--what is the money actually being used for on the ground?

MS. ANSTEY: Let's take another one in the front row here. I forgot to ask people, for the sake of the transcript which we hope to post, can you identify yourselves and your news outfit?

QUESTION: You have shared that this credit that you have available for Africa, the $500 million, is a very flexible one in that you can go to the Board, or you can even bypass the Board one way or another, if this is ever possible. Can you tell me a little bit about this mechanism and how it works?

MS. ANSTEY: Let's take one more back in the third row, please.

QUESTION: My name is Philip Tazi, and I am the President of the African Correspondents Association, and I also write for the Cameroon Herald.

I have two quick questions. The experience that African countries have had with loans from major institutions like the World Bank has been rather disastrous, because most of the money is usually not used for what it was intended. My first question is given that so much money is being given to many of these countries to fight HIV/AIDS, what guarantees are put in place to make sure the money is used toward that end?

My second question is more a rather personal one, because I went back to Cameroon last year after a 10-year absence, and I was really, really amazed at how many of my friends and brothers and sisters have died of AIDS. So when I came back to Washington, a few of us decided to launch a small foundation to sensitize people back home about how deadly this disease is.

What really amazed me, talking to young people in Cameroon in December, was that most of them really believe that AIDS doesn't exist. Last week, we sent our first consignment of condoms, and also pamphlets which were collected from agencies here, to Cameroon.

What I want to know is what assistance do we have, because we ended up raising more than $500, our small foundation. Given the fact that many of us from Africa know that most of the money which is given by the World Bank will definitely not get down to the grassroots, that is, to the people who really need it, what assistance can we expect to benefit, either from institutions like the World Bank or from some other, smaller institutions? I know that there must exist much smaller institutions that would be able to provide assistance to small foundations like ours.

MS. ANSTEY: Thank you.

Debrework?

MS. ZEWDIE: Yes. The billion dollars that you quoted is money that the World Bank has spent ever since the beginning of the epidemic. The first project was in 1986. So the money that has been loaned for AIDS, that is the figure.

I didn't understand what you meant when you asked would this money go to countries that the Bank does not do business with, so you'll have to explain that to me.

QUESTION (Mark Egan, Reuters): What I was trying to find out was how much are you going to be spending; how much is it going to be ramping up to?

MS. ZEWDIE: Okay. For Sub-Saharan Africa alone, this is $500 million. The document went to the Board on the 12th of September, and the graph that I showed you, if by the end of this fiscal year, we finalize all those countries, it would be $515 million.

QUESTION (Mark Egan, Reuters): On top of the $1 billion?

MS. ZEWDIE: The $1 billion is the accumulated from 1986, so that yes, it is on top of the $1 billion.

What is it used for was your other question. It is used for prevention, care, and treatment activities. The national AIDS control programs of the countries have drawn their priorities, and they can use it to finance these priorities. So that is what it is going to be used for. It is the country that determines whether they want to use it for condoms or whether they want to use it to buy drugs for opportunistic infections or any of these things.

The difference here would be the coverage, the scaling up. There are bits and pieces of interventions in every country that do well. What we need to do now is to scale it up so that it has a larger coverage.

The Multi-Country AIDS Project--you must be an insider--yes, you are right--what we did when we took the two countries to the Board was for the Board to give the following mandates. One, unlike other projects, now the mandate for the $500 million has been given to the regional vice president. So a project, instead of going to the Bank, all those countries, apart from Ethiopia and Kenya, which have already gone to the Board, will not have to go to the Board. They will go to the vice president, and the Board will have a 10-day grace period if they have any concerns.

And since we are using the two countries as templates, the idea is to shorten the processing time. So indeed there is a bypass, we are bypassing the Board, and that is how we can process this many countries in a short time.

What guarantees do we have? Unfortunately, I don't think I have the slide here, but the two features that stand out in the Multi-Country Project are the negotiation with governments to allow the bulk of the money to go directly to the communities. So if you take Kenya and Ethiopia, for example--if you take Ethiopia, there is a horrendous bureaucratic system of the money getting from the capital city to the community. Also, the country is made up of autonomous regions, so the regions themselves have their own hierarchy.

What we have negotiated with the government is that the money would now go directly from the capital city to a small community in any of the regions, which would have a bank account, a program, and a committee to deal with that. So that is one thing that stands out, and that we hope will be a guarantee that the money goes to the community who is dealing with prevention and care by and large.

Cameroon is one of the countries that you have seen already. The idea is to make sure that the national program of Cameroon gets enough funding so that there are enough condoms, there are enough drugs for treatment, et cetera. If the program is successful, then, hopefully, you don't have to send condoms to Cameroon; the national program would have enough funding to cover the country.

Unfortunately, the way the Bank does business is directly with governments, so that whatever we do in Cameroon would have to be done in negotiation with the Government of Cameroon, who could release some of the money to NGOs that are working outside of Cameroon even. But that is the prerogative of the Government as to how they want to use the money.

MS. ANSTEY: I just want to follow up on that. Somebody asked about the Brazil program. In Brazil, for example, World Bank money has gone to help work with about 175 local NGO groups who altogether have distributed about 180 million condoms in Brazil. So that I think this image that you have of this large institution, top-down approach, is actually wrong. We are working very extensively with local communities and local NGOs to tailor the programs, as Debrework said, to the local conditions.

Mike Phillips and then Sebastian.

QUESTION: Mike Phillips, Wall Street Journal.

I understand that the international organizations and UNAIDS are negotiating or helping negotiate with the drug companies to lower the price of the antiretroviral drugs and that that could get the price down to maybe $900 a year or $1,000 a year or something for the treatments. But besides that, what is the Bank or UNAIDS doing, or what can they do, to provide those treatments for people in countries in Africa in particular--or is it simply too expensive, and in essence are the Bank and UNAIDS saying, We can't help these people with that particular avenue of relief.

MS. ANSTEY: Sebastian?

QUESTION: Sebastian Mallaby, from The Washington Post.

Could you talk a bit more about what should be done now in Russia and Eastern Europe? I assume that Senegal and Thailand, the two countries you cited as being successful models of containment, are sufficiently different that they don't necessarily describe the route ahead. So what should be emphasized?

MS. ANSTEY: Debrework, do you want to take those two?

MS. ZEWDIE: I would like Jacob to add onto the first question about the antiretroviral drugs. What is happening now--let me go back a few steps. The five pharmaceutical companies came and spoke to these organizations, as I told you earlier, and negotiations started. In the middle of the negotiations, the countries--the idea, first of all, was for Sub-Saharan Africa specifically. During the Global Health Assembly, the African countries were not very happy with the way the negotiations were going between the pharmaceutical companies and the UN agencies, and rightly so. They said "Who are you, negotiating this on our behalf?"

So we backtracked, and there is now a committee which consists of the agencies, pharmaceutical companies, and country representatives. The stage we are at now is the pharmaceutical companies would have a direct negotiation with the countries. Senegal is one good example, where a dialogue had started with these pharmaceutical companies, and they had brought down the cost very, very substantially--almost $1 a day.

There are about ten countries lined up, and these dialogues would continue. So our job as the UN cosponsors is to facilitate this dialogue. So that is what is going to happen. And this is specifically for antiretroviral drugs.

There are two types of care--what is known as essential care and comprehensive care. What we don't have, especially in Sub-Saharan Africa, now is essential care. Essential care is treatment for opportunistic infections, treatment for STDs, including treatment for mother-to-child transmission.

The Bank funds essential care. Even before we started with the MAP, the Bank was funding all treatments except mother-to-child transmission. Now the drug which is available has been made available free-of-charge for the next five years from the company that makes it. So our task will be to make sure we have the minimal infrastructure to support that and move along.

So what we are talking about now is the comprehensive care which includes antiretroviral drugs. One of the prohibiting factors was the lack of infrastructure in most of the developing countries. There was a meeting of African scientists about a month ago in Dakar, and the conclusion from that meeting is that Africa maybe does not need all these sophisticated laboratories to be put in place. If you have a couple things that will help you monitor the treatment, that would be sufficient. That would bring the cost down substantially.

We have spelled out in the MAP that we will be engaged in building the health infrastructure to facilitate the use of the drugs. So it is not as drastic as the Bank and UNAIDS saying "We can't do anything, and let somebody else do it." We are trying to do as much as we can within our capacity. It is not morally appropriate to go to a country like Cameroon, for example, where we don't even have enough condoms, enough opportunistic infection drugs, enough painkillers, and say to the Cameroonian Government, "You need to have access to antiretroviral drugs" on our part. There are some nuances there. There are governments who come and request UNAIDS and the Bank, saying, "I have this bit of educated manpower in my country, and it is being decimated. What can I do?"

So it is something which is very difficult which needs to be worked out. However, both UNAIDS and the Bank and the other cosponsors are trying to make sure that these drugs indeed get to the people who need them. So we have moved a long way already,and we are moving toward that. And the pharmaceutical companies are becoming very, very responsive, from giving it free to a reduction of 90-95 percent.

QUESTION: (Sebastian Mallaby, The Washington Post): Are there cases--you just mentioned the educated class has been decimated--are there countries that are making a conscious triage decision that we can afford antiretroviral drugs for the doctors, the nurses, the lawyers, the professors, but then saying we can't afford them for the rest?

MS. ZEWDIE: Not in public.

QUESTION: In private?

MS. ZEWDIE: In private, yes.

QUESTION: Which countries?

[Laughter.]

QUESTION: I'm sorry--what?

MS. ZEWDIE: I'll tell you the countries later on, off the record. Yes, there are countries who, even before the negotiations with the pharmaceutical companies, have been sending these few people to neighboring countries to have treatment. Some of them have dealt with it internally now. Botswana is a very good example where the crisis had reached a point where the Government had to open its doors and say, "Come and help me." And that is what is happening with one of the pharmaceutical companies that is willing to provide all the antiretroviral drugs that Botswana needs. But Botswana is one-point-something million people. We have Nigeria on our hands.

MR. GAYLE: Can I answer that as well? I was going to just quickly add to the last comment. I think that even before the negotiations with pharmaceutical companies and discussions, if you look historically, countries have always had to make those kinds of decisions, and whether it was providing drugs only for those who had acquired infection due to involuntary means, blood transfusion, rape, other kinds of things like that, countries have been doing that over time. That's nothing new.

What happens now is that there are some new dimensions in the formula for countries to take into account when they make these kinds of sovereign decisions. But just to say as well that as we look at the number of people who are infected worldwide, when we recognize that somewhere between 80 to 90 percent of them do not even know of their own infection, it means that before we even get to the point of distributing drugs equitably, we have to make sure that we have the voluntary counseling and testing opportunities for people to find out their status, and beyond that, then, the kinds of health care infrastructures to ensure that people are taking the proper drugs at the proper time and in the proper way so that we don't instead cause a drug-resistant epidemic worldwide.

So we have got various steps that have to be met before we get to the point of making sure the drugs themselves are available to all. All must first know that they even need the drugs and can access them and use them properly.

One of the beauties of the World Bank being one of the lead members of partnerships such as UNAIDS or the International Partnership Against AIDS in Africa is that I think these opportunities can take advantage of all of our comparative advantages to bring together on a comprehensive kind of challenge like first finding out HIV status, then having the right environment for proper care and treatment, then having the kinds of drugs, et cetera, et cetera, et cetera.

And just very quickly, coming back to some of the questions that came up here about non-member World Bank countries, again through a partnership of being able to use influence and support, the World Bank as a UNAIDS member has been able to influence and support other donors to be able to support countries that the World Bank itself cannot work in.

MS. ZEWDIE: I think there was one question on what can be done in Eastern Europe. A number of things. There is nothing to date which beats prevention. So that is one thing that could be done. In order to be able to do that, there has got to be a drastic change in the denial that exists in Eastern Europe now and putting appropriate policies in place. If injection drug users are stigmatized and forced to go into hiding, there is no way this epidemic would be curbed in Eastern Europe.

So there are a number of things that have been shown to work in a number of countries which could easily be adopted by the Eastern European countries, but I think the big prohibiting factor here is the denial and the lack of appropriate policies to protect the injection drug users.

MS. ANSTEY: Let's go to Andre Sitov in the middle row.

QUESTION: Andre Sitov from TAS.

To rephrase a question asked earlier by one of my colleagues when he asked about countries that the Bank normally doesn't lend to needing the money for fighting AIDS, to rephrase that, would countries that, would countries without an active IMF program be eligible for the Bank moneys to fight AIDS?

And in the same context, some of the countries that you mention here that seem to be doing a good job, like Belarus, for instance--it is not on good terms with the IMF currently. You don't seem to have a program to help them fight AIDS, and it is not in the pipeline. Is it because they didn't ask for it or for another reason?

MS. ANSTEY: Yes, in the front.

QUESTION: You mentioned participation in international partnerships and so on. I want to ask you to what extent you are working with the U.S. Government, particularly after the U.S. Congress passed legislation for the creation of a trust fund for AIDS, which so far, from what I know, is vacant--there is no money requested for this fund by the U.S. administration. Are you supporting the creation of this trust fund?

And then, if you can tell me what is the amount of funds that the Bank will be spending for fiscal year 2000 for AIDS.

Thank you.

MS. ANSTEY: Yes.

QUESTION: Ruben Barrera, with Notimex.

Going back to Latin America, out of Brazil, I was wondering what is the Bank doing in other countries, especially poor countries like Bolivia or Ecuador; and also, Central America, because in the overview that you present, you completely omit Latin America, and it seems like things are going at least well in that area--or maybe the impression is that at this point, the majority of countries in Latin America are able at this point by themselves to attend to this crisis.

So I was wondering what the Bank is doing in that Region.

MS. ZEWDIE: Let me combine the two questions and address them, and I'll ask Jacob to add to it.

Last spring, during the Annual Meetings of the World Bank and the IMF, the President of the Bank came out and said that any country that has a decent national program will not go unfunded. That is what we are operating under.

To my knowledge, I don't know a single country, whether it is Belarus or any other country, that has approached the Bank to have funding for HIV/AIDS and has been rejected.

Secondly, we also don't sit and wait for countries to come. There is a tremendous effort throughout the Bank in all the Regions to give HIV/AIDS the visibility that it deserves at the center of the development agenda. So everybody within the Bank, especially people who are working on HIV/AIDS and related issues, whenever they go to do business on education or infrastructure or agriculture, they do bring up HIV/AIDS issues. The finance ministers and the plan ministers, when they come annually to the Bank, the Bank President talks to them. So it is a two-way street. We are trying to do our best, and hopefully, the governments will respond as well. It is the same thing for Bolivia and Ecuador.

We did invite the focal person for Latin America. Unfortunately, he is not around. He could have told you much more. But the principle of the Bank is that if countries want loans for HIV/AIDS in their countries, the loans are available.

The question was asked, does the Bank lend money to countries who are not active with the IMF--what we did, for example, when we went to our Board with the $500 million, we had to choose our battles, if you wish. We had a number of layers of problems to be solved. The first one is to get enough IDA funding, which is not part of the country ceiling--a different pot to fight the HIV/AIDS epidemic in Sub-Saharan Africa. We wanted to open a window so that we could bring all the other questions through that window. It is countries in arrears, countries in conflict, and subregional activities. We would love to have a program for Southern Africa, for example. These are countries that are hit hardest by the epidemic.

So the first question we went to our Board with was the $500 million, which is not part of the countries' allocation. So Kenya or Ethiopia or Cameroon do not have to worry that they would be using their IDA allocation for HIV/AIDS. So this is a separate pot of money from the IDA allocation for each country.

The questions which we flagged to the Bank Board are countries in arrears, countries that are not active with the IMF--what do we do with this. The Board has instructed us to come back to them with a concept note, which we are working on. So that is the next step that we will be taking up with our Board.

What is the budget like for fiscal year 2002. It goes along with what I said earlier. If 10 or 20 countries come tomorrow to the Bank and say "We need to borrow money to fight HIV/AIDS," that would become the budget for 2002. In a span of a few months, as I just told you, we had only two or three pipeline projects in the Africa Region, and now it is $500 million.

QUESTION: Are you working with the U.S.?

MS. ZEWDIE: Yes.

QUESTION (Mark Egan, Reuters): Could you clarify on the money, though--how much money does the Bank have available in the coming years to spend on these projects? This is a question which you have not been answering. How much do you have available to you in the coming years to spend on this?

MS. ZEWDIE: Let me give you a very short answer. The Bank, especially the Africa Region, has not been able to utilize the IDA allocation it has been given year after year after year. So it is almost unlimited. That is the answer.

MS. ANSTEY: And the President has made that commitment very clearly, that the resources will not be a problem; the resources will be available.

I also just want to make clear that in the handout we have outside, we have a list of all of our projects, country by country, how much money, an d we also have the list of what is in the pipeline. So that is available outside. It goes through every, single country that we are lending to. It is at the back of something called the "World Bank HIV/AIDS Activities," and you can pick it up outside.

MS. ZEWDIE: Let me respond to the partnership question.

The Multi-Country AIDS Project for Africa is under the International Partnership for HIV/AIDS, which is a partnership of African governments, private sector donor agencies, et cetera, and we work very closely with the U.S. Government.

The MAP in Kenya and Ethiopia has been in partnership with all the major players in those countries. The first thing we do in fact when we initiate a MAP project in any country is to have a consensus workshop where we bring all the players so they can work with us. In some of these countries, at least in Ethiopia and Kenya, the U.S. is going to fund part of the loan for both countries; so that is how closely we work.

The trust fund, as you know, is new. I don't think we have reached a stage where we will be able to draw down the money. So that's where it is. But we work closely with them.

Maybe Jacob would add on both of these.

MR. GAYLE: Sure. And in terms of the trust fund, of course, while there have been some funds that have been appropriated, we are sort of waiting for a President, and then I think they'll move further. But I think there are some things that are happening right now, however, are postponed until some other, larger political things are settled here in this country.

In terms of Latin America, I think there are at least three ways that the World Bank is currently involved with some of the countries that you mentioned, but throughout Central America and South America, and if you want to include as well Dominican Republic. Firstly, within the existing projects and activities that are funded through World Bank loans, especially health projects, the World Bank is working together with the country partners to ensure that HIV/AIDS components are incorporated in already existing activities--what would be called "retrofitting"--similar to what is going on with all activities within Africa, this is now being accomplished throughout Latin America as well.

In terms of UNAIDS, again, the World Bank being a major and one of the founding members of the UNAIDS Partnership, there is then representation of the World Bank in many of the countries throughout Central America, most of the countries within South America as well, that relate to trying to be able to bring the technical resources to bear.

What we have seen in our success cases worldwide is that it is not money that has made the difference, but it has been first political commitment and then also really bring social responses to AIDS together--government, nongovernment, and other sectors. That is where we see ourselves currently, more so within Latin America, occurring, and the World Bank is quite involved in that partnership effort.

And then, thirdly, there is a regional technical support initiative that has been developed for Latin America and the Caribbean called CIDALAC. CIDALAC is supported wholly, fully, through World Bank funds that are sent to the region through the UNAIDS Partnership.

MS. ANSTEY: Yes, sir?

QUESTION (Philip Tazi, Cameroon Herald): As I mentioned earlier, I visited three African countries last year--Benin, Nigeria, and Cameroon--and what I discovered was a little bit puzzling to me, because it is not really the unavailability of condoms. Condoms are pretty much affordable to anyone who wants to use condoms. I found that condoms were being sold at every street corner. So it is not very much the fact that condoms are not available. It is simply that people just don't want to use them.

I say this because when we came in, I saw the film that was showing, which I believe is probably the most powerful way to get to people, to let people know that AIDS is real. Because what is happening in Africa is that most people just don't believe it is real.

Now, are there any suggestions, any initiatives, to sponsor any programs that would actually go on the spot--I am saying this because if most Africans watched the film that was showing, they just wouldn't take it seriously, because most HIV infections are spread in Africa through heterosexual sex. So are there any efforts for any organizations to go out on the spot and produce something that would be personalized probably for each country, because I believe this is probably the most powerful way to get the message out.

MS. ANSTEY: Yes. I'm going to answer that one, because the Bank for the first time, really, this last year, as I said, had this partnership with MTV. It has also had a partnership with CNN with public service announcements on AIDS, on the importance of using condoms. They have been running all around the world for the whole year. This is very new work for the Bank.

We would like very much to do more, and we are trying to do more, working with local radio in countries to see how we can devise communication strategies on the ground to go hand-in-hand with projects. One thing that the Bank is doing much more of now, not just in AIDS but on a whole range of social issues, whether it is girls' education, is trying to devise communication strategies in the field, working with local people, designed by local people, to persuade mothers to send their children to school or to persuade people to use condoms.

We anticipated some problems with our Board when we had this very high-profile campaign with CNN around the world which is being broadcast throughout Africa, even mentioning the word "condoms"--we anticipated that some Executive Directors would not like that, but in fact it has been very well-supported throughout the world.

QUESTION: Can you briefly describe the terms of the loans and how they are to be repaid?

MS. ZEWDIE: There are two types of loans--what is known as IDA, the International Development Agency, and IBRD, the International Bank for Reconstruction and Development. Apart from Brazil and a couple of other countries who have an IBRD loan, most of the Bank's money, the Bank's loans, go to countries on IDA terms. What are the IDA terms? First of all, it is zero interest; about .75 percent processing fee; a 10-year grace period, and a 40-year repayment period.

So currently, the grant element of IDA funding is about 65 percent. So literally, 65 percent of the $500 million is grant. That is the money which most of the countries that we work in are accessing.

Brazil, on the other hand, is a country which in Bank terms has "graduated," and the loan is an IBRD loan. The IBRD loan has interest, but very low interest compared to market rates of other banks.

QUESTION: (Sebastian Mallaby, The Washington Post): Have you seen any willingness in countries like South Africa and Botswana, which are IBRD borrowers, to actually borrow at IBRD terms for this purpose?

MS. ZEWDIE: South Africa is borrowing for other health issues, not specifically for HIV/AIDS. The health program which we have in South Africa has a very small HIV/AIDS component, and we were in the process of moving toward a freestanding HIV/AIDS component when all the problems with the existence of the virus came up.

Botswana, no, because Botswana at this moment is probably one of the few countries in the world that has more than adequate funding. As I told you earlier, there is a pharmaceutical company which is going to provide 100 percent of not only the drug, but the prevention and care and treatment and everything associated with it. A number of donors have gone to Botswana, and Botswana comparatively is a rich country which has a good infrastructure.

Namibia, which is also an IBRD country, and Swaziland, have shown some interest, especially if we could lend to them on IDA terms. That is something which would have to go to our Board, and the Board has to see this not only in the African context but in the context of the globe, where other countries, for example, China, might say, "I need to borrow money for HIV/AIDS on IDA terms" as well. So this is something which is beyond at least our current discussion now.

MS. ANSTEY: I think that's it, ladies and gentlemen. If you have any side questions, I'm sure Debrework and Jacob and Martha and Mead will be available. I think they are going to show a few minutes of the MTV movie now, for those who are interested.

Thank you.

[Whereupon, at 11:02 a.m., the press briefing was concluded.]