Most of the world’s 35 million people living with HIV and AIDS reside in developing countries. In 2013, 2.1 million people became newly infected with HIV, and 1.5 million died of HIV-related illnesses. Sub-Saharan Africa accounted for almost 70% of all new infections and more than two-thirds of all HIV-related deaths globally. While 12.9 million people worldwide can access treatment, it only represents 37% of all people living with HIV. Without effective HIV prevention, the number of people requiring treatment will become unsustainable.
The World Bank helps define the global response to HIV and AIDS and contributes to the achievement of the 2015 Millennium Development Goals. As a co-sponsor of UNAIDS, the Bank embraces the vision of “Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths”, and brings to the AIDS response its unique cross-sectoral expertise.
The World Bank offers financing, specialized technical support and knowledge to countries for effective prevention of new HIV infections, care and treatment for people living with HIV/AIDS, and alleviation of social and economic consequences for affected communities.
Upon request from national governments (and as part of the World Bank Country Partnership Strategies developed with the countries), the Bank provides financing (grants, credits and loans) for HIV/AIDS programs, through stand-alone projects, or typically, integrated with broader health sector financing, through results-based financing for health systems strengthening, or financing for projects including other social sectors, infrastructure, transport or urban development. Since 1989, World Bank financing for HIV and AIDS has totaled over $5 billion. As of FY13, the World Bank’s active portfolio for HIV/AIDS stands at $1.5 billion.
The World Bank also supports countries to do “better for less” through actionable, analytical work and technical assistance to help countries improve the implementation, efficiency, effectiveness, and sustainability of their own national AIDS responses. The Bank supports analytical work to help countries maximize their HIV resource allocations, and identify what to invest in: (i) allocative efficiency; (ii) effectiveness studies; (iii) financing and sustainability studies; and/or (iv) national strategic planning. The Bank also supports countries in their efforts to understand how to better deliver HIV services and attain quality standards and coverage levels targeted in their national strategic plans. The Bank works with stakeholders to improve evidence related to HIV prevention and engages in key sectors such as education, transport, energy, and infrastructure.
Through the International Development Association (IDA) the World Bank’s Fund for the Poorest, the Bank has helped to save lives and improve the health of millions in developing countries. Some examples of IDA results from 2000-2013:
Provided more than 117 million people with basic packages of health, nutrition, or reproductive services;
Provided 194 million pregnant women with antenatal care during a visit to a health care provider;
Ensured that 1.3 million adults and children received antiretroviral combination therapy;
Purchased and/or distributed 386 million condoms for the prevention of HIV, sexually transmitted diseases, and unwanted pregnancies;
Trained 2.6 million health personnel to improve the quality of health services delivery.
In addition, the World Bank has reported the following results over the course of the epidemic:
The Multi-Country AIDS Program (MAP) was the first billion dollar AIDS initiative, which helped to transform the global AIDS response into a multi-billion dollar effort.
The World Bank has funded about 50,000 community AIDS organizations globally, helping to create effective community responses in more than 50 countries.
The World Bank has assisted 125 countries to better understand their AIDS epidemics, improve the implementation of their programs, the sustainability of their HIV programs, the effectiveness of resource allocations, and 100 countries to strengthen their AIDS national strategic plans.
Country and regional-level HIV and AIDS results include the following:
In Rwanda, integrated, incentivized AIDS service delivery supported by the World Bank contributed to a 76% increase in overall health service utilization.
A regional project supported by the World Bank in West Africa’s transport corridor reduced sexually transmitted infections by 22%.
In India, the national AIDS program with support from the World Bank, prevented an estimated 3.5 million of India’s expected 5.5 million HIV infections.
The Bank is continuously gathering knowledge about “what works”, evaluating, for example, the impact of short term financial incentives on HIV and STI incidence among youth in Lesotho and showing that conditional cash transfers can lead to a measurable decline in HIV incidence.