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World AIDS Day 2010: Are We Finally Turning the Tide?

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  • New UNAIDS report shows compelling progress against HIV/AIDS; since 1999, new HIV infections have fallen 19%.
  • A total of 5.2 million people in low- and middle-income countries now receive life-saving antiretroviral drugs, a 30% increase over 2008.
  • Bank studies in Malawi, Tanzania show innovative HIV prevention strategies can work.

November 24, 2010—Since 1999, the year in which it’s thought that the AIDS epidemic peaked globally, the number of new HIV infections has fallen by 19%, prompting policymakers and scientists to suggest we may now be witnessing a turning of the tide in preventing the further spread of HIV and reversing the epidemic.

As the world prepares to mark the 30th anniversary of the first clinical identification of HIV, new numbers from UNAIDS provide compelling evidence that the epidemic can be defeated. 

The agency’s annual report on the state of the global and national HIV/AIDS epidemics—released yesterday—provides  new data from 182 countries, and,  for the first time, includes trend data on incidence from more than 60 countries, and country- by- country scorecards on key issues facing the AIDS response.

“This must be one of the most encouraging and substantive reports on the course of the epidemic we’ve seen in years,”says Dr. David Wilson, the Director of the World Bank’s Global HIV/AIDS Program, and a leading international authority on HIV epidemiology and prevention. 

“And yet, despite this good news about falling HIV infections, incidence remains unacceptably high. Consider that South Africa alone is home to about 1 in 5 people worldwide living with HIV; and that women between 35-39 years of age are seeing their numbers go up, while among young people, HIV infections are staying stubbornly high. “  

Wilson says the new report shows that an extra 1.2 million people are now taking life-saving antiretroviral drugs, bringing the total number of people receiving treatment in low- and middle-income countries to 5.2 million, a 30% increase over 2008.

Bank Studies in Malawi, Tanzania Show Progress

Wilson describes the new treatment numbers as an inspiring achievement. However, he cautions that for every person on treatment, another two become newly infected with HIV. This shows how vital better prevention is to blunting and turning back the epidemic.

 “Countries just can’t win against this kind of deadly ratio and so we have to look at new ways to make prevention work because we’ll never be able to treat our way out of this epidemic,says Wilson, who helped to launch two new World Bank studies at the Vienna AIDS summit last July.

The studies showed that cash payments given to men and young women in Malawi and Tanzania were linked to significantly lower HIV and other sexually transmitted infection rates than in other groups in the same communities.

 In the Malawi study, which the Bank conducted with researchers from George Washington University and the University of California, girls who enrolled in the cash transfer program were given small amounts every month if they regularly attended classes. Eighteen months after the program began, new HIV infections among girls in the program were 60% lower than those who were part of a control group and did not receive payments.

Programs like these could become an important missing part of effective HIV prevention strategies,” says Berk Ozler, a Senior Economist with the World Bank’s Development Research Group, who conducted the Malawi study with external researchers.

“These findings suggest that empowering girls financially can also lead to reduced risk – not just by reducing their sexual activity or having safer sex, but also by enabling them to choose partners who are less likely to be infected with HIV.” 

Prevention Essential Among Vulnerable Groups

According to the Bank experts, preventing new infections among sex workers, injecting drug users, men who have sex with men and other marginalized groups is also an essential priority in better national HIV/AIDS strategies.

A Bank report from South Asia, Tackling HIV-Related Stigma and Discrimination in South Asia, describes how, despite widespread prevention and other efforts to reduce high-risk behaviors such as unprotected sex, buying and selling of sex, and injecting drug use, HIV vulnerability and risk remain high.
With the search for an AIDS vaccine still coming up empty-handed, and the lingering impact of the global recession squeezing country AIDS budgets and donor aid, it’s increasingly clear that HIV stigma and discrimination are more than a cause of sorrow borne by people living in the shadow of the disease, say Bank experts.  They are also key drivers of new infections, a trend that demands urgent attention at the country level.

“Discrimination against people in these high-risk, marginalized groups is so strong that they feel their lives aren’t worth protecting or prolonging, which stops them from reaching out for the prevention, treatment, care, and support services they need to fight the disease,”says Dr. Mariam Claeson, Program Coordinator for the World Bank’s South Asia region, and co-author of the new report.

“We have been supporting efforts that tackle prejudice about HIV and AIDS at community and national levels and break down the walls of fear and suspicion that poison the lives of people with, or at high risk of acquiring, HIV and AIDS.”

A Serious Development Challenge

As the world prepares to mark a deadly milestone in the history of HIV/AIDS― 2011 will mark the 30th anniversary of the first cases of a mysterious new illness in men in Los Angeles and New York that would later become known as AIDS―the World Bank continues to recognize AIDS as a serious development challenge. The pandemic has not only inflicted widespread human tragedy, but has robbed countries of parents, citizens, and workers, causing serious economic loss.

To date, the Bank has provided $4.5 billion for HIV prevention, treatment, care and support programs in developing countries. Since 2006, 4.3 million people have received counseling and testing through Bank-supported projects focused on HIV prevention. During the past year alone, the Bank provided $630 million in funding disbursements and new commitments for HIV and AIDS programs, helping poor countries fill critical gaps in AIDS prevention, treatment, and mitigation.

To make sure that HIV/AIDS programs are more effective and sustainable over the coming years, Global AIDS Director Wilson says the Bank must continue to integrate its HIV work with its broader mission to help developing countries strengthen their overall health systems to improve the state of people’s health.

“We have to move AIDS treatment away from a purely emergency response towards a sustainable long-term future by folding AIDS prevention, treatment and other health-related HIV services into stronger national health systems that make health and development dollars work reciprocally together for maximum effect,” Wilson said.

The World Bank is a founding co-sponsor of UNAIDS, the global United Nations team that coordinates the global response to HIV/AIDS.

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