Fight Not Over on 20th Anniversary of World AIDS Day
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- AIDS is not only a health problem, but society's problem
- Prevention cannot be left behind
- The social impacts could be much greater and broader than economic loss due to workers' sickness
December 1, 2008—It has been 20 years since the first World AIDS Day drew attention to the HIV/AIDS epidemic.
Today, with some 33 million people living with HIV, World AIDS Day and
events like the International Conference on AIDS and STIs in Africa,
taking place in Senegal, December 3-7, remain “extraordinarily
important for those who are trying to fight AIDS in this world,” says
Shanta Devarajan, Chief Economist for the World Bank’s Africa region.
AIDS
is increasingly seen as not only a health problem, but society’s
problem, says Devarajan. “We need all the resources and all the
mechanisms that we have in society to fight AIDS.”
HIV/AIDS Increasingly a Development Priority
Finance
ministers and heads of state in hard-hit Sub-Saharan Africa, such as
Uganda President Yoweri Kaguta Museveni, are increasingly making the
battle against HIV/AIDS a top priority, he adds. South Africa has
rolled out one of the biggest antiretroviral (ARV) treatment programs
in the world.
At the same time, the price of advanced ARV drugs
has dropped dramatically. About 3 million people worldwide are now on
treatment. Stigma against people living with HIV has also eased in some
countries despite the significant obstacle it poses for prevention,
treatment and mitigation efforts.
In Rwanda, for instance, there
has been a “massive increase in the number of people that have come to
be tested, and as access to AIDS treatment has scaled up people have
become more accepting of those living with AIDS,” says World Bank
Senior Health Specialist Miriam Schneidman.
Rapid Scale-Up of Treatment Urgently Needed
Schneidman
says AIDS has long been seen by the Bank as a major development issue.
The Bank’s early efforts laid much of the foundation for later work
done by the Global Fund and US President's Emergency Plan for AIDS Relief (PEPFAR), now major funders of anti-retroviral treatment in Africa.
In
the last six years, the Bank has mobilized approximately $2 billion
through grants, loans and credits to programs to fight HIV/AIDS. The
Multi-Country HIV/AIDS Program (MAP) for Africa has made available $1.6
billion to 35 countries, including five sub-regional (multi-country)
initiatives. Total Bank financing for HIV/AIDS since 1988 is close to
$3.9 billion.
While access to antiretroviral treatment has
improved markedly, now reaching about 30 percent of those who need it,
differences in coverage across countries are enormous—from below 5
percent to over 90 percent.
Prevention Cannot Be Left Behind
While
HIV prevention efforts are paying off, with behavior change noted
particularly among young people. For every two people in Sub-Saharan
Africa gaining access to treatment, five become newly infected. This
ratio must change.
In addition to increasing access to treatment,
proven, targeted prevention efforts must recognize and adapt to
changing transmission patterns and focus more on behavior change rather
than solely on raising awareness.
Targeted interventions are
needed for women, especially young women, to reduce their vulnerability
as well as for men to increase their adoption of prevention mechanisms.
They are also needed for populations at most risk, such as sex workers and men who have sex with men.
Future Generations at Stake
Prevention
and treatment for all who need it are critical to reduce the impacts of
AIDS on current and future generations, says Devarajan.
World
Bank researchers originally projected HIV/AIDS would mainly impact
economies through loss of workers due to sickness, but the social and
economic impacts could actually be much greater, he says.
Children
of people with HIV/AIDS are more likely to leave school to help ailing
parents run households and because families cannot afford to keep them
in school.
“This means that the effects of HIV/AIDS aren’t just
on the current generation but are much longer term,” says Devarajan.
“You might have a whole generation of people whose parents were
affected by AIDS who are less educated and in turn are less able to
educate their children. The transmission mechanisms could go on for
generations.”
Preliminary analysis of some of the countries with
a high incidence of HIV/AIDS indicates GDP “could not just grow slowly
but could actually start declining…it could mean than in three or four
generations GDP could decline to about half its original size.”
Providing
treatment to AIDS patients so they live longer and can care for their
children is one solution, says Devarajan. Another is providing AIDS
orphans with an education “so they don’t miss out on educational
opportunities that some of their peers have.”
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