The World Bank pioneered global HIV and AIDS financing early in the emergency and remains committed to achieving Millennium Development Goal 6, to halt by 2015 and begin to reverse the spread of HIV and AIDS, through prevention, care, treatment, and mitigation services for those affected by HIV and AIDS.
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Social and structural factors - like poverty, marginalization and stigma - and not just individual behaviors are shaping the HIV epidemic in Europe and Central Asia. This is the main conclusion o... Show More +f a new report released today by the World Bank Group, the World Health Organization Regional Office for Europe and the London School of Hygiene & Tropical Medicine.The study systematically reviews evidence on HIV vulnerability and response in all 53 countries of the WHO European Region, stretching from Iceland to the borders of China.The report focuses on key populations most at risk of HIV infection: people who inject drugs, sex workers and men who have sex with men. It confirms that they are disproportionately affected by the growing HIV epidemic in Europe, where the number of reported HIV cases reached more than 1.5 million in 2011.HIV cases in these three groups account for approximately 50% of total diagnoses. Economic volatility and recession risks are increasing vulnerability to HIV and infections.Key findings in the report include:25% of HIV diagnoses in Europe were associated with injecting drug use, with much higher proportions in Eastern Europe (33%) than in Western Europe (5%) and Central Europe (7%).HIV remains relatively low among female sex workers in Europe who do not inject drugs, (less than 1%), but higher among those who inject drugs (over 10%) as well as among male and transgender sex workers.Sex between men accounted for 10% of all HIV diagnoses in Europe, with higher rates reported in Western Europe (36%), followed by Central Europe (22%) and Eastern Europe (0.5%). However, the increase was higher in Central and Eastern Europe.The analysis highlights the pivotal role of environmental factors in shaping HIV epidemics and HIV prevention responses. Barriers to successful HIV responses include the criminalization of sex work, of sex between men, and of drug use combined with social stigmatization, violence and rights violations.HIV prevention requires social and environmental change, and the report calls for policymakers and HIV program implementers to target the right policies and programs to maximize the health and social impacts of Europe’s HIV responses and get higher returns on HIV-related investments.Read the Synthesis ReportRead the Policy Brief in English | Russian Show Less -
March 9, 2010—As soon as she discovered she had tuberculosis (TB), Maria Stepanova made preparations for her own death. She wept inconsolably and bought herself a pretty outfit to wear in ... Show More +her coffin. As a sanitation worker scrubbing floors at a tuberculosis dispensary, she knew first-hand the heavy toll exacted by the disease in Russia. Russia’s TB mortality rate is among the highest in Europe. In Novosibirsk, the capital of Siberia where Stepanova lives, almost one in three TB infections is fatal.“I knew how it all finishes. I was surrounded by death,” she says three years later.When a World Bank team visited Novosibirsk as part of project supervision, Stepanova, a chirpy 46-year old carefully attired against the autumn chill, was alive and well. Her first grandchild had been born recently, she had resumed her hospital work and she was confident that the rigorous anti-TB treatment she followed had rid her body of the debilitating disease.Spurred by a TB and HIV/AIDS Control Project supported by a $150-million loan from the World Bank over 2003-2008, Russia’s health care system adopted a more rigorous strategy for the diagnosis and treatment of tuberculosis, both among civilian populations and in the prison system across the country.The strategy encourages earlier and more accurate detection of TB cases through sputum smear microscopy, standardized treatment regimens of 6 to 8 months under direct observation (to assure compliance and avoid drug resistance), and the maintenance of a standardized recording and reporting system.This strategy, promoted with technical assistance from the World Health Organization, represents a momentous “paradigm shift for Russia,” according to the World Bank project’s team leader Patricio Marquez.Additionally, the project supported the development of guidelines and protocols in line with international standards for HIV/AIDS prevention, diagnosis, treatment and follow-up, while strengthening the public health laboratory and surveillance systems.TB Deaths, HIV Rates DropTB mortality in the total population decreased by 15.4 percent from 2006 to 2007, and among prisoners – the most affected group – TB deaths dropped by 37.5 percent. There was also a 72.7 percent increase in TB patients receiving the standardized treatment regimen, including directly observed treatment. The rate of increase in HIV prevalence dropped by 7.7 percent between 2006 and 2008. HIV-positive infants born to HIV-infected women decreased from 13.6 percent to 9.8 percent between 2004 and 2008.According to Svetlana G. Safonova, Chief, Medical Administration of the Federal Correction Service (Prisons) of the Russian Federation and doctor of biological sciences, “The best way to tell this story is by the results. During the last five years of its implementation, the project helped reduce TB prevalence rate by 20 percent and TB mortality rate by 33 percent in the institutions of the Federal Correction Service. By the end of 2008, overall implementation of the TB/AIDS Control Project resulted in increasing coverage of TB patients by bacteriological tests up to 95 percent.”Restructuring Health Care DeliveryIn parallel, Russia’s Health Reform Implementation Project, funded as a 2003-2008 pilot project in the Chuvash Republic and Voronezh Oblast, along with support at the federal level, tested new approaches to restructuring health service delivery, for later replication in other regions.A third project in the Chuvash Republic , launched in 2009 in partnership with the International Finance Corporation (IFC) under a sub-national financing mechanism, is building capacity to prevent and treat cardiovascular diseases and injuries—the leading killers in Russia. Health service improvements contributed to decreased infant mortality rates and increased life expectancy of the population (above the average in Russia) in the two pilot regions.The Bank is also providing technical advice on a fee-for-service basis to regional governments such as in the Khanty-Mansiysk Autonomous Okrug and the Kirov Oblast, while sub-national lending is geared to help restructure the organization of health service delivery, as is currently being discussed in the Vologda Oblast. The use of these new mechanisms is highly relevant to other middle-income countries.Besides national institutions, the World Bank has established partnerships and mobilized additional resources by working with a number of international agencies on health sector improvement in Russia, including the World Health Organization, UNAIDS, Global Fund to Fight AIDS, Tuberculosis and Malaria, Canadian International Development Agency, US Agency for International Development, US Centers for Disease Control and Prevention, International Transport Forum, OECD, U.K Department of Health, Public Health Agency of Canada, Finland National Institute for Health, Bloomberg Initiative to Reduce Tobacco Use, the UK National Institute of Health and Clinical Excellence (NICE), and the Bill and Melinda Gates Foundation.According to Marquez, “The real value of the World Bank Group involvement in middle-income countries such as Russia is to help foster partnerships, disseminate knowledge and promote evidence-based innovation.” Show Less -