Abid Aslam
WASHINGTON, May 15 2008 (IPS) – The World Bank says it is recalibrating its financing for anti-AIDS efforts in Africa, which shoulders more than two-thirds of the world s HIV/AIDS burden.
Some 22.5 million Africans are HIV-positive, and AIDS is the leading cause of premature death on the continent, according to the bank. Hardest hit are productive young people and women. So much so, that many private firms recruit two workers for every job in anticipation of losing staff to the disease.
So far, the bank has thrown most of its money 1.5 billion dollars since 2000 behind what it terms emergency response measures such as providing antiretroviral drugs to fight the disease in more than 30 African countries.
Millions of lives have been saved as a result and in some of these countries, HIV/AIDS prevalence rates have fallen. Even so, millions more have died and even now, for every new patient receiving antiretroviral therapy (ART), four to six other people are being infected for the first time, the global lender said in its Agenda for Action, 2007-2011 , released Wednesday.
More than 22 million Africans have died from the disease, and about as many as are currently infected, with 1.7 million of the new infections taking place within the past year alone.
The prevalence of HIV/AIDS appears to be falling in Kenya and in parts of Botswana, Cote d Ivoire, Malawi, and Zimbabwe. However, prevalence rates exceed 15 percent in at least eight countries: Botswana, Lesotho, Mozambique, Namibia, South Africa, Swaziland, Zambia, and Zimbabwe.
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By some forecasts, 40 percent of today s 15-year-old Africans will eventually become infected.
ART is being administered to about a million people in the region a mere 23 percent of those who need it. Reasons for the shortfall include cost but also the stigma attached to seeking treatment, the logistics of treating people in remote areas, and an acute shortage of skilled medical staff.
Against this backdrop, the bank said it would change its approach in favour of advising countries on tailoring prevention strategies aimed at slowing and reversing the rate of new HIV infections.
With AIDS the largest single cause of premature death in Africa, we can t talk about better, lasting development there without also committing to stay the course in the long-term fight against the disease, Elizabeth Lule, manager of the bank s AIDS team for Africa, said in a statement.
At the global level, the lender will advise countries on how best to manage their international financing, which the bank said is characterised by complexity , a euphemism for the grab-bag of disparate political and practical terms, conditions, and reporting and other administrative requirements that come with the mess of multilateral, bilateral, and private money that is being thrown at the epidemic.
In part, this new global tack is designed to help African countries to tap tens of billions of dollars in new funding from sources including the U.S. President s Emergency Plan for AIDS Relief (PEPFAR) and the Swiss-based Global Fund to Fight AIDS, Tuberculosis, and Malaria.
At the national level, the bank said it would help countries to accelerate implementation and take a long-term sustainable development approach to HIV/AIDS. Additionally, it would seek to strengthen countries capacity to track the efficiency, effectiveness and transparency of their HIV/AIDS response, and to build stronger health and fiduciary systems.
At the local level, the bank will seek to amalgamate HIV/AIDS services with those for reproductive and maternal health, nutrition, and other diseases such as malaria and tuberculosis (TB). It said this would remedy a long-standing defect in many national HIV/AIDS programmes to date.
The feminisation of the epidemic and its links to sexual and reproductive health, and the frequency of co-infection with TB (and the emerging Extensively Drug Resistant TB) and other opportunistic diseases, amplify the importance of providing people with integrated health services, the bank said.
According to the bank report, more than 60 percent of people living with HIV in Africa are women, and young women are six times more likely to be HIV-positive than are young men. As a result of the epidemic, an estimated 11.4 million children under the age of 18 have lost at least one parent.
Specifically, the bank said it would commit to provide at least 250 million dollars a year for HIV/AIDS initiatives and establish a grant incentive fund of 5 million dollars annually to promote capacity building, analysis, and HIV/AIDS project components in key sectors such as health, education, transport, and public sector management.