Friends and Colleagues,

HIV/AIDS has spread with ferocious speed. All but unknown a generation ago, today it poses the foremost and fastest-growing threat to development in the region. By any measure, and at all levels, its impact is simply staggering:

At the regional level, more than 11 million Africans have already died, and another 22 million are now living with HIV/AIDS. That is two-thirds of all the cases on earth.

At the national level, the 21 countries with the highest HIV prevalence are all in Africa. In Zimbabwe and Botswana, one in four adults is infected. In at least ten other African countries, prevalence rates exceed ten percent.

At the individual level, the arithmetic of risk is horrific. A child born in Zambia or Zimbabwe tonight is more likely than not to die of AIDS. In many other African countries, the lifetime risk of dying of AIDS is greater than one in three.

This fire is spreading. AIDS already accounts for 9% of adult deaths from infectious disease in the developing world. By 2020, that share will quadruple to more than 37%. The global death toll will soon surpass the worst epidemics of recorded history. And unlike those prior plagues, AIDS could well remain with us for decades to come. Combustion is fearfully fast. In South Africa, the prevalence rate grew tenfold in five years.

Tragically, mass killers are nothing new in Africa. Malaria still claims about as many African lives as AIDS does, and preventable childhood diseases kill millions of others. From a public health standpoint, AIDS has added a grave new challenge to what was already an arduous agenda.

But what sets AIDS apart is its unprecedented impact on development. Because it kills so many adults in the prime of their working and parenting lives, it decimates the workforce, fractures and impoverishes families, orphans millions, and shreds the fabric of communities. The costs it imposes force countries to make heartbreaking choices between today's lives and future lives, and between health and the dozens of other vital investments for development. Sometimes development itself even contributes to the spread of AIDS. Labor migration, urbanization and culture change can all carry the disease to new realms.

As a result, AIDS is swiftly undoing the achievements of the past 30 years. Life expectancy--the best overall measure of development--is now declining in a host of African countries, a macabre reversal of the rapid progress in the years following independence. In the worst-hit nations, life expectancy a decade from now will be 17 years shorter than it would otherwise have been--47 instead of 64. That is nothing short of catastrophic.

In short, much of Africa will enter the 21st century watching the gains of the 20th evaporate.

This is a regional emergency. If Africans and their partners do not contain this fire, little else we do will last or matter. This is not a health issue. It is a development challenge of the highest order.

To date, two forces have helped feed the flames: ignorance and inaction. Ignorance is rapidly vanishing, largely extinguished by the pandemic itself. AIDS is everywhere evident in Africa, including in countries that have been spared the worst. It was even front-page news in USA Today last week. Inaction, unfortunately, remains common. The official response to AIDS has in too many cases been late, timid, and limited to the health sector. Even now, few countries treat the issue with the priority and urgency it demands. This is tragic, because there are dozens of measures that have been proven successful by courageous countries such as Uganda. Especially for the many countries where prevalence is still low, every day of delay is a gamble with disaster.

And we must be honest with ourselves: We in the Bank have not done our full part. True, many country and task teams have done excellent work on AIDS. The Bank has published some of the leading analytical work on the subject. The Human Development family in particular has built strong projects and partnerships, and helped bring the scope of the crisis to light. But as an institution, we have failed to bring to bear the full weight of our collective instruments, intellect and influence. As Africa is the hardest hit, we in this Region bear the primary responsibility to lead.

Implementing the strategy will be the responsibility of the entire Region. Experience has shown that a successful HIV/AIDS effort requires full-scale involvement; it cannot be left to one team or unit. At the same time, country and sector teams will need a source of support, advice and referrals which they can rely on as they mainstream HIV/AIDS. We have therefore created a dedicated, multisectoral AIDS Campaign Team for Africa, or ACTafrica. This team will be based in the Office of the Regional Vice Presidents--the first time since the Renewal Program that we have located a topical group in the front office. This high-level placement conforms to the best practice advice we give our clients. It underscores the priority we attach to this issue and it enables the team to ensure maximum possible collaboration among the sector families.

The team will be headed by Debrework Zewdie and will include Sheila Dutta, the two of whom have done an outstanding job in developing the strategy. Other core members will include Keith Hansen, who served on the AIDS strategy steering committee and has long been involved with AIDS in the Region. Core members yet to be recruited include a rural development specialist with substantial experience in community-based programs, and a broad-based economist with significant public sector expertise.

Most of ACTafrica's work will be demand-driven and funded from country budgets. The team will serve as the region's focal point and information clearinghouse on AIDS, and will provide several specific services, including:

Equipping and supporting country teams to mobilize African leaders, civil society and the private sector to intensify action against AIDS. This will be important everywhere, but especially so in the countries where prevalence is still low. The sense of urgency may be lower there, yet such countries stand the most to gain by stopping the fire from spreading.

Supporting country teams, sector families and task teams in integrating AIDS into their portfolios and country programs. This will include retrofitting projects with AIDS components where possible, helping in developing new dedicated AIDS projects, and building AIDS mitigation components into other projects wherever necessary. It will also mean including AIDS in key non-lending services such as public expenditure reviews and economic projections.

Supporting country teams in giving AIDS meaningful treatment in all Country Assistance Strategies

Enhancing our work on the economic and social impact of HIV/AIDS

Incorporating an AIDS impact assessment module into our existing environmental and/or social assessment processes

Collecting and disseminating information on the progress of the epidemics, country-by-country statistics, and best practices

Strengthening and expanding our partnership with UNAIDS and its co-sponsors, as well as with key agencies, NGOs and interested bilaterals

In addition to its core members, ACTafrica will also have "affiliated" members throughout the Region. These affiliates will be staff and managers who are contracted to help expand the capacity and sectoral expertise of the team. We expect ACT affiliates to come from all four sector families as well as from Operations Support, Resource Management and Information Technology, and the Regional Service units. The team will work in continual collaboration with UNAIDS to maximize access to the best global resources and expertise. ACTafrica begins its work immediately.

It is easy to despair of AIDS. But let us bear in mind the many formidable challenges that Africa has already faced and overcome: wars of independence, global economic upheaval, droughts, floods. Then let us remember that unlike any of these, AIDS is completely preventable.

Recently, a history of the World Bank's first fifty years was published. In its more than 1,900 pages, including a 100-page chapter on Africa, the word "AIDS" barely appears. A generation from now, when the next such history is written, we can be certain that the pandemic will play a far more prominent role. Those who look back on this era will judge our institution in large measure by whether we recognized this threat for what it was and did our utmost to put out the fire. They will be right to do so.

Let's get to work.

Callisto & Jean-Louis