Address by Mr. Callisto Madavo
U.S.-Africa Business Summit
Philadelphia, PA, November 2, 2001 Distinguished guests,
It is truly an honor to be here today to discuss the most challenging development and security issue facing Africa today: HIV/AIDS.
Let me begin my remarks by commending the African presidents, prime ministers, and other officials who have made the long journey to take part in this important event. It is a time of uncertainty in the world, and your presence in this hall underscores your deep commitment to African development including the fight against HIV/AIDS. Your presence also shows solidarity with the American people. You have refused to give in to fear, and that is an inspiration to us all who live in this great country.
THE SCOPE OF THE CHALLENGE
Mr. Chairman, just to focus our minds, let me briefly remind you of the numbers.
Today, more than 36 million people worldwide are living with HIV/AIDS. Seventy percent of them are African. Today, more than 16 million women worldwide are living with HIV/AIDS. Eighty-two percent of them are African. Today, more than 1.4 million children worldwide are living with HIV/AIDS. Seventy-nine percent of them are African. And today, well over 13 million children worldwide have been orphaned by AIDS. Ninety-two percent of them are African.
These statistics continue to alarm even those of us who have worked on HIV/AIDS issues for many years. But let us not get caught up only in numbers¯infection rates, prevalence rates, mortality rates. Behind these numbers there are husbands, wives, parents, children, farmers, teachers, doctors, and yes, politicians, bankers, and businesspeople. It's as if the wellspring of African knowledge and wisdom is being drained away right in front of our very eyes. But I especially grieve for the children. We need to secure their future.
Indeed, HIV/AIDS is no longer simply a health issue in Africa. It is a full-blown development crisis. In many countries, HIV/AIDS is wiping out most of the hard-earned gains of the last century. For example:
Life Expectancy. Life expectancy is now declining in a host of countries after decades of progress.
Health. Health care systems are stretched beyond their limits and collapsing as they deal with a growing number of AIDS patients.
Education. Across Africa, teachers and students are dying or dropping out of school for economic reasons. This is taking a heavy toll on Africa's future prospects.
Agriculture. HIV/AIDS reduces investments in irrigation and other capital improvements, thereby slowing agricultural production. As one farmer in Malawi remarked, "We are spending more time turning the bodies of the sick than we are turning the soil."
Private Sector. As all of you know, businesses throughout Africa are facing significant increases in costs due to absenteeism, higher labor turnover, and increasing recruitment, training, and staff welfare costs. Many of Africa's most skilled workers and business leaders are being lost.
Clearly, HIV/AIDS affects every sector of development in Africa. But, as I alluded to at the beginning of my address, HIV/AIDS also affects national security, an issue heavy on our minds in light of the recent events in New York and Washington, DC. One does not have to be a social scientist to know that people who are unhealthy, people who cannot feed their families, people who cannot send their children to school, and people who cannot feel secure in their homes and communities are likely to be frustrated, angry, and prone to violence. Sadly, this is the legacy of AIDS in Africa. The epidemic breeds instability, and instability fuels further spread of the epidemic. Of the countries in Africa with the highest HIV prevalence, half are engaged in conflict of one kind or another.
THE GOOD NEWS
Now you may be saying, "We've heard the bad news, Madavo. Is there any good news?" There is indeed hope on the horizon. We have the knowledge and the tools to slow HIV/AIDS and prolong the lives of those already infected. But unfortunately, after 20 years, the fight against the epidemic is still being waged on too small a scale. We need a massive scaling up of resources¯ both human and financial¯if we are going to mount an effective response.
This requires all of us in this hall to ask a few basic questions: "What can we do, together, to break the vicious circle of AIDS, poverty, conflict, AIDS? What can governments, businesses, international financial institutions such as the World Bank, and others do to protect Africans from the terror of HIV/AIDS and make people feel more secure in their homes and communities?" As we were reminded at the UN General Assembly Special Session on HIV/AIDS last June, each of us has a strong role to play in this effort. What then are these roles?
Let me begin with government. Strong government commitment has proved essential in every country that has made headway against the HIV/AIDS epidemic. Leaders need to speak openly about HIV/AIDS, overcome taboos, and place the epidemic at the center of their development agendas. Leaders also need to improve the health infrastructure so that people in all geographic regions and in all socioeconomic groups have equal access to quality HIV/AIDS prevention, care, and treatment services. In sum, each government needs to create an enabling environment so that all sectors of society, including the private sector, can contribute to an intensified response. I know from my recent travels in Africa that governments are stepping up to meet these challenges.
Unfortunately, there remain a few isolated cases where public policy—in spite of evidence from science—is still condemning millions to die. I ask you: can there be any moral justification for muddled and confused leadership in this area?
Second, business can make a huge difference in the fight against HIV/AIDS. I see two major roles: addressing HIV/AIDS in the workplace, and developing AIDS treatments and vaccines.
Regarding workplace interventions, businesses can play a crucial leadership role in the communities where they operate. They have the potential to reach millions of workers and their families with HIV/AIDS prevention, care, and treatment services. They can also mitigate the impact of the epidemic by addressing HIV/AIDS in company health and life insurance plans, and in pension programs. Helping employees and their families cope with HIV/AIDS is not only the humanitarian thing to do, it is also good business. With proper treatment, workers can stay on the job, benefiting not only their employers but also their families and communities.
Throughout Africa we see shining examples of business cooperation in the fight against HIV/AIDS. Let me cite a few examples:
DaimlerChrysler/South Africa is working to prevent HIV/AIDS among auto workers and their families. Under an innovative partnership with GTZ, DaimlerChrysler has implemented a comprehensive corporate policy for HIV/AIDS at several of its auto plants. In-depth HIV/AIDS education for the workers, their families, company doctors, and local authorities is a major part of the program. Importantly, the program includes reform of company health insurance and pension schemes.
Eskom, a power and utility company in South Africa, provides employees at all levels with peer-led HIV/AIDS education, currently covering more than three-fourths of the workforce. Eskom has incorporated HIV/AIDS campaigns into a range of company training and induction programs. They have also distributed condoms to the workforce and have installed condom dispensers in most of the restroom facilities in their operations. Other initiatives have sought to extend HIV/AIDS education into the wider community through radio and television talk shows, press articles, and HIV/AIDS events for the public.
Chevron Nigeria Limited has engaged in a range of HIV/AIDS education activities as part of the Chevron Workplace AIDS Prevention Program. Workplace awareness and prevention campaigns have focused on different types of employees, ranging from administrative office employees to construction workers, management staff, and field-based oil workers. They have also joined with labor unions to strengthen the role of union leaders in workplace interventions. Chevron is extending HIV/AIDS education workshops to the local community, showing again that business can be a good corporate citizen and a powerful ally in the fight against HIV/AIDS.
There are many more examples one could cite!
What about the role of business in developing affordable treatments? Private businesses are leading efforts to develop treatments that prolong life for those living with HIV, and vaccines to defeat the virus once and for all. Pharmaceutical companies such as Boehringer Ingelheim, Bristol-Myers Squibb, Merck and others are advancing the state of the art in HIV/AIDS research, moving us to a point where HIV can be treated as a chronic illness.
But, as we all know, HIV/AIDS drugs remain out of reach for the vast majority of the 25 million Africans who need them. Pharmaceutical companies have recently done the right thing and cut their prices to make the treatments more affordable. They have also joined with the Bank and the UN family in an important initiative, Accelerating Access to HIV Care, which seeks to dramatically expand the availability and affordability of HIV/AIDS drugs, including antiretrovirals, in developing countries. Boehringer-Ingelheim has gone a step further. Last year the company agreed to provide Nevirapine, which can prevent mother-to-child transmission of HIV, to African governments free of charge for five years.
THE ROLE OF THE BANK
What about the international financial institutions? At the World Bank, we are engaged heavily on the issue. Let me update you on our recent progress.
Almost three years ago, as the International Partnership Against AIDS in Africa was being established, we pledged that the Bank would adopt a sweeping new strategy to address HIV/AIDS more forcefully in Africa. In September 1999, at the 11th International Conference on AIDS and STDs in Africa, held in Lusaka, I launched that strategy. At the same time, we committed the Bank to mainstream HIV/AIDS into all areas of our work and all aspects of our dialogue with our member countries.
How are we achieving these goals? Let me touch on a few of the tools we are using:
We are "retrofitting"¯that is, adding new HIV/AIDS components to¯many of our existing African projects to support immediate action to tackle AIDS in all sectors.
We are building HIV/AIDS components into new projects where possible. For example, as part of the Chad/Cameroon pipeline project, the Bank is supporting capacity-building and workplace interventions along the pipeline route, both for workers and for the affected communities.
We are integrating AIDS into debt relief programs. As you know, the Bank and the International Monetary Fund are helping process billions of dollars in debt relief under the Heavily Indebted Poor Countries Initiative. Many of the countries that will benefit are heavily affected by the epidemic. We are working to ensure that some of this debt relief goes to increase funding for HIV/AIDS.
We are also requiring attention to HIV/AIDS in all PRSPs. It is vitally important to address the socioeconomic factors that make people vulnerable to HIV infection if national programs are to succeed. And ownership – by all participating in the national development process – is critical.
And importantly, we are working to resolve the severe resource constraints that still leave millions of Africans beyond the reach of HIV/AIDS prevention, care, and treatment efforts. Clearly, money is not the magic bullet, but it is part of the solution, and there is still too little of it. We and UNAIDS now estimate that a basic program of prevention, care, and treatment in every African country would cost between US$3 billion and US$4 billion each year. Current investment in HIV/AIDS in Africa unfortunately is nowhere near that figure.
Mr. Chairman, the Bank is mindful of its comparative advantage in leading efforts to bridge the funding gaps. After the Lusaka conference in 1999, we began designing a new initiative to that end. The result? The Multi-Country HIV/AIDS Program (MAP) for Africa, which has set aside an initial amount of US$500 million in IDA credits to scale up effective HIV/AIDS interventions. IDA credits are "soft loans" given on highly concessional terms. The grant element of the "loans" is on the order of 65 percent, meaning that 7 of every 10 dollars are grants.
Since September 2000, when MAP was approved by our Board of Directors, we have approved about US$400 million of the initial US$500 million for projects in Burkina Faso, Cameroon, Eritrea, Ethiopia, Gambia, Ghana, Kenya, Nigeria, and Uganda. An additional 20 countries have sought Bank support under the MAP. Shortly we will ask our Board to replenish the MAP with another US$500 million. This request will include US$100 million of resources to address cross-border issues, such as transportation corridors, that are missed by country-specific lending.
In addition, we are preparing to extend support to the African countries that are not eligible for IDA credits. After all, how can we focus only on lower-income countries in Africa when relatively well-off countries such as Botswana, Swaziland, Gabon and others have some of the highest HIV prevalence rates in the region? The short answer is, we cannot. We are exploring foundation and donor funding to "buy down" standard IBRD lending terms to more concessional IDA levels. This will enable the IBRD countries to borrow for HIV/AIDS on IBRD terms but pay back on IDA terms.
Mr. Chairman, as you can see, the Bank intends to be comprehensive in its approach to HIV/AIDS in Africa. This means that we will continue to focus on HIV/AIDS prevention, of course, but also on care and treatment for the millions of people who are already infected with the virus.
In a world where 36 million people are living with HIV/AIDS, it is neither sensible nor humane to exclude care. Given the vicious circles that AIDS drives, care in many cases is an essential part of prevention. We will increase our support for care for those infected and affected by the virus, as well as for orphans and others made more vulnerable by the epidemic.
Of course the dream in the long run¯the ultimate security measure¯is an effective HIV vaccine for all the world. The Bank has therefore been a supporter and active member of the International AIDS Vaccine Initiative (IAVI) and the Global Alliance for Vaccines and Immunizations (GAVI). Over the past two years, the Bank's AIDS Vaccine Task Force has worked with IAVI to find innovative strategies to accelerate the development of an AIDS vaccine targeted at the needs of developing countries.
Finally, the Bank welcomes the effort to establish the Global AIDS and Health Fund and looks forward to helping realize this important initiative. The Fund can go far in filling the funding gaps that inhibit the fight against HIV/AIDS and other communicable diseases. So far, some US$1.5 billion has been pledged to the Fund by governments, corporations, multilateral institutions, foundations, and individuals. The Bank will play whatever role it may be asked in order to make the Global Fund a success.
Mr. Chairman, allow me to end where I began. Africa has to wage a relentless struggle against HIV/AIDS to secure the future of the continent and its people. Some might say we have no choice; this in my view is pessimistic and timid. An optimistic way of looking at it is that with determined leadership by Africans and strong support by Africa's partners, the struggle can be won. Let us together go forth and win. Together we can do it. Thank you.
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