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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Thirty years ago, newspaper headlines were rife with news of a virus that even doctors were unfamiliar with. Little was known about a strange epidemic that later would take the lives of music legends ... Show More +such as Freddy Mercury and Héctor Lavoe and several Hollywood stars.Today we know that the disease does not distinguish by sex, race or religion. It is the same illness that has killed 25 million people worldwide. Nowadays it is an old acquaintance whose name is no longer a novelty: AIDS.The characteristics of the epidemic differ by region. 69% of people infected with HIV live in Sub-Saharan Africa, for example, and only half of them receive antiretroviral therapy. By contrast, in Asia the epidemic is concentrated among sex workers and intravenous-drug users. “In the case of Latin America, the virus is prevalent among men who have sex with men. The epidemic is kept hidden due to the stigma of people living with HIV and discrimination with respect to sexual orientation,” says Fernando Lavadenz, senior health expert at the World Bank.The Latin American and Caribbean region has substantially reduced HIV prevalence during the past decade. “It went from being the region with the worst burden of HIV-AIDS death and illness in the 2000s to being the fourth most affected region after Sub-Saharan Africa, south Asia and east and central Europe in 2010,” says Lavadenz.Access to treatment is the keyToday, the HIV epidemic in the region has stabilized: more than 1.6 million Latin Americans are affected, but according to UNAIDS data, AIDS-related deaths declined by 36 % between 2001 and 2012. The World Health Organization (WHO) reports that currently, 600,000 more people are receiving antiretroviral therapy in the region as compared with 2003.Argentina is a case in point. “The disease burden has been significantly reduced by several factors, including, and perhaps most importantly, the free, universal access to antiretroviral drugs,” explains Lavadenz.A World Bank study carried out with support from UNAIDS reported that thanks to available treatments, at least 4,300 people were saved from illness in Argentina between 2001 and 2010. The country allocates 80% of total HIV/AIDS spending to care and treatment, compared to a regional average of 75%. “It is also a question of knowing how to spend well,” says Lavadenz. The study found that despite the high cost of antiretroviral drugs in Argentina, the National AIDS program is cost beneficial. “The benefits were not only in lives saved but also in savings of over US$ 748 million in Argentina, estimating the costs saved in the complicated treatment of people with advanced disease and the transmission that was avoided,” says the expert.“This is a successful case in which HIV treatment was the best prevention and a good lesson for Latin America,” he says.Laws in favorAlong with Brazil, Argentina was one of the first countries to provide free treatment to people living with HIV. The National AIDS Law, among other mechanisms, mandated the government and all other health providers to provide medical, pharmacological and psychological treatment to people living with HIV.“In Argentina, more than 80% of reported HIV cases have received treatment, which the WHO defines as universal access,” says Lavadenz.Additionally, the equal marriage law – Argentina is the first Latin American country to support same-sex marriage – and the gender identity law – the only law in the world that upholds the rights of transsexuals– have favored HIV prevention and treatment. “These laws made the country a pioneer in reducing the stigma,” says Lavadenz. “Less stigma, less shame in going to a hospital, taking a test or receiving medical attention in a democratic, non-discriminatory way.” Show Less -
KINGSTON, Jamaica, November 12, 2009--Among the Caribbean nations, Jamaica has the third largest number of people living with HIV or AIDS. There are roughly 25,000 people in Jamaica infected with the ... Show More +AIDS virus. The prevalence of HIV is 1.5 percent among the general adult population, but it is much higher for female sex workers, men who have sex with men, and prison inmates. Overall, the main challenge for Jamaica is to reduce transmission among vulnerable high risk groups and prevent an escalation that would reach epidemic proportions.APPROACHThe first AIDS case was reported in 1982, and in 1986 the government of Jamaica initiated its National HIV/STI Program, which has been guided by a series of medium term strategic plans. In 2001 the government of Jamaica adopted an ambitious plan for the expansion of prevention and treatment strategies with the support of the World Bank -- the 2002-2006 HIV/AIDS National Strategic Plan (NSP).The Bank was well-placed to support this operation. In June 2001 it had launched a lending program for HIV/AIDS in the Caribbean. The first phase of that included funds for the Dominican Republic and Barbados. The second phase included support for the Jamaican initiative, which amounted to an infusion of US$15.13 million over a six-year period between 2002 and 2008. The bulk of the funding, or US$10.6 million, came from the World Bank, and roughly a third, or US$4.53 million, came from the government of Jamaica.In tandem with the World Bank, other entities contributed significant sums to combating HIV/AIDS in Jamaica, notably the Global Fund Tuberculosis, AIDS & Malaria. By mid-2008 when the first phase came to an end, there had been substantial gains in terms of treatment, prevention, capacity and infrastructure. But the problem was far from resolved. Changing certain at-risk behaviors had proven over the years to be a very difficult task.The government of Jamaica renewed its commitment to fighting HIV/AIDS with the approval of the 2007-2012 NSP, the latest salvo in its 23-year-old National HIV/STI Program. And the World Bank followed suit. It approved another US$10 million loan with co-financing of US$1.5 million from the Jamaican government.HIGHLIGHTSThe first phase of World Bank assistance tackled the issue on essentially two fronts – prevention and treatment, but the ability to do that also required extensive investments in personnel and equipment. Some efforts were extremely successful, others less stellar, but in the end the World Bank helped Jamaica save hundreds of lives that would have otherwise been lost to the AIDS virus, and it assisted in the creation of an extensive infrastructure capable of addressing the HIV/AIDS problem.Saving lives: Treatment strategies led to a substantial reduction in the number of AIDS-related deaths from 665 in 2004 to 320 in 2007. This was due in large part to a US$6.6 million grant from the Global Fund that allowed for the purchase of anti-retroviral drugs. Prior to 2003, less than 100 people in Jamaica were on antiretroviral treatment. By the end of the project in mid-2008, that number had reached 4,400.Testing and treatment of those who tested positive improved dramatically. The entire inmate population was screened for HIV; 95 percent of those who attended prenatal clinics were also screened; of those who tested positive, 85 percent received anti-retroviral drugs, up from 10 percent in 2002.Training: Thousands of people have received training in an HIV/AIDS-related field. For example, 2,653 people received extensive HIV management training known as Voluntary Counseling and Testing, or VCT; 246 prison guards, 241 inmates, and 174 other members of Jamaica’s security forces were trained to be peer educators; and 120 people were trained to go into night clubs, guest houses, hotels, massage parlors, etc., to work in prevention.A change in attitude: Anti-stigma campaigns resulted in a more positive attitude toward those infected with the AIDS virus. There was a 10 percent increase in overall acceptance levels from 2004 to 2008; close to 83 percent of respondents said they would be willing to take care of an HIV-infected family member; and 76.4 percent said they would support an HIV-infected female teacher who wanted to teach.100% Coverage: Jamaica now has 19 HIV/AIDS treatment sites located throughout the country. They serve 360 clinics in the nation’s 14 parishes, and each one has diagnostic and treatment capabilities as well as comprehensive ambulatory care.LOOKING FORWARDAn intertwined set of cultural, economic, social and behavioral factors are still driving the HIV/AIDS epidemic and will require more extensive prevention campaigns and treatment strategies. But the World Bank and the government of Jamaica, as well as other organizations, are committed to working together to help the nation stem the tide of HIV/AIDS. Show Less -