World AIDS Day 2002

World AIDS Day 2002

Stigma and discrimination blunt progress; focus on prevention, treatment, care and support are key

On December 1, people around the world will mark World AIDS Day and underscore the need to roll back the epidemic. In sub-Saharan Africa alone 29.4 million people are estimated to be living with HIV/AIDS, and the epidemic threatens to expand in India and other parts of Asia, as well as other regions. As World AIDS Day approaches, DevNews is running a series of articles looking at the epidemic and its impact on people and development across the globe.

November 27, 2002—For more than two decades, HIV/AIDS has been ravaging the lives of people from all walks of life, in every country. Every year the numbers of people infected or affected by HIV/AIDS increase, and this year will be no different.  In a new report released yesterday, UNAIDS estimated that globally more than 42 million people are now living with HIV, five million people have been newly infected with HIV, and AIDS has claimed 3.1 million lives this year.

Stigma and discrimination rank highly on the list of barriers to curb the epidemic, and are closely linked to overcoming successful HIV/AIDS prevention, treatment, care and support programs. "We see success in countries where they have publicly embraced the epidemic and have tried to do something about it," says Debrework Zewdie, World Bank Global HIV/AIDS Program head, speaking on the theme of this year’s World AIDS Campaign. "Countries that have embraced the epidemic do better than those which are still in denial. The very people who are stigmatized can become a powerful force to evoke change in every community."

While addressing the issue of HIV-related stigma and discrimination is important, the development community must focus on successfully implementing prevention, treatment, care and support programs. "As far as prevention of HIV/AIDS is concerned, most countries have managed to put solid prevention programs in place," says Zewdie. "People know how the disease is transmitted, and how to prevent it; however, we still haven’t made a dent on behavioral change. In the area of care and support our response lags way behind the support and need that these millions of people require."

AIDS activists took center stage at the International AIDS Conference in Barcelona in July this year. Their main issue was the lack of access to HIV/AIDS treatment, especially in developing countries. In an effort to make progress in this area, a goal was set at the Barcelona conference to treat three million people living with HIV/AIDS in developing countries by 2005, a target established in June 2001 by the UN General Assembly Special Session (UNGASS) on HIV/AIDS.

"We have no choice but to achieve this goal," says Zewdie. To monitor progress, a steering committee comprised of the Bank, the World Health Organizations and other leading agencies was established. The committee will disclose a roadmap on World AIDS Day revealing how the international community can achieve this target.

Although the price of AIDS drugs has come down substantially in recent years, it is still out of reach for most of the countries which have disproportionately been affected by this epidemic. Even in situations where countries can afford to get some of the drugs, many do not have the infrastructure in place.

"Tertiary infrastructure, for example, where hospitals and laboratories do advanced lab work, is not what we’re referring to," says Zewdie. "We are talking about the basic health infrastructure which would follow-up with patients and give them the support that would be required to keep people healthy."

Poverty and lack of human capacity are major obstacles to providing adequate care to HIV-infected people in developing countries. "In most developing countries, poor people get treatment for a limited amount of time, and treatment is later discontinued," says Zewdie. "In some countries where we have resources we lack human capacity to move progress ahead. In most cases, we have been very successful in providing technical assistance, but we have been less good at building local capacity."

"All development agencies need to look back and focus on this issue. HIV/AIDS erodes the little human capacity that exists in many of these countries."

Sub-Saharan Africa and the Caribbean still remain the most HIV/AIDS-affected regions. The scale of the problem is enormous—35-40% of the adult population is estimated be living with HIV/AIDS in Botswana alone, and the 20 countries with the highest prevalence rates in the world are located in sub-Saharan Africa.

Data suggests that the epidemic is moving ahead in Asia, and that one country to note in particular is China. The Chinese government has recently acknowledged that the epidemic is moving from high-risk groups to the general population, and that is "a frightening situation," says Zewdie. "As much as we continue to do what we need to be doing, we also need to provide the same resources that Africa and the Caribbean need, which is less than 10-20% percent of the need now," says Zewdie.

"A drastic and quick response is needed so we don’t see what is happening in Africa and the Caribbean repeat itself in any form or size in Asia. If it does, then it will be much greater than what we have already seen in Africa."

Zewdie reminds us that the HIV/AIDS epidemic is not the problem of a single country, but rather an international problem. Zewdie recommends that each country should ask themselves, "Have we done enough?"

The international community needs to ask itself the same question. Clearly, much remains to be done, but there are some positive developments.

The World Bank is playing a vital role in curbing the epidemic globally through the Multi-Country HIV/AIDS Programs (MAP) in Africa and the Caribbean. With $1 billion to fight HIV/AIDS, the program works by supporting a country’s strategy to fight HIV/AIDS through increasing access to prevention, care, support and treatment. Projects totaling roughly $500 million have been approved for 16 countries, and at least 12 more with an estimated value of $300-400 million are currently under preparation.

Zewdie stressed that the MAP is a new way of doing business, and while it is making progress, the pace of implementation, is not yet as fast as it should be. "The good news is lessons from the first projects approved under the MAP are being fed into the second generation of MAP approvals to good effect. Nevertheless, there are both country and Bank factors inhibiting faster, more effective implementation, which would benefit from capitalizing on the continued strong support from World Bank president James Wolfensohn and the Bank’s senior management."

Beginning in late November, in recognition of World AIDS Day, a number of activities will take place around the globe. The World Bank, as well as many other international agencies, will hold events such as the Bank sponsored global video conference involving Barbados, China, Moldova and Tanzania held yesterday which addressed the social issues related to HIV/AIDS for better results.

"I hope everyone will take part in events in their local communities," says Zewdie. "Each of us has an important role to play in fighting HIV/AIDS."

For more on the Bank’s work in the area of HIV/AIDS, visit: www.worldbank.org/aids

Or  click herefor more on the new report by UNAIDS, Epidemic Update 2002