The spread of HIV/AIDS has added another element of risk to the lives of poor people. The World Bank is working with a broad range of aid agencies, nongovernmental organizations and governments to find ways of halting and reversing the spread of HIV/AIDS in developing countries.

In its efforts to support the fight against HIV/AIDS, the Bank has forged partnerships with the World Health Organization, the Joint United Nations Programme on HIV/AIDS, and many others.

Around 42 million people were living with HIV/AIDS at the end of 2002, 95 percent of them in developing countries and 70 percent in Sub-Saharan Africa. World Bank research has found that half of all new adult HIV infections occur in the 15-24 age group. Another Bank study found that when 8 percent or more of a population becomes infected with HIV, the economic growth rate in the country is reduced by one percentage point every year.

This was the threat facing Uganda in the early 1990s when the country's HIV/AIDS prevalence rate reached 14 percent of the population, rising to 30 percent in some Ugandan cities. An estimated 2 million people were infected, and nearly one million children were orphaned.

Uganda fought back by developing one of the most comprehensive HIV/AIDS programs in Africa. The World Bank supported it with a $50 million program, initiated in 1994.

The program promoted safe sex and education about how HIV/AIDS spreads. It also tried to mitigate the effect on the families of those infected with the disease.

The Bank subsequently provided another $47.5 million to expand these successful prevention, care, support, and treatment programs throughout the country. This effort was mounted in concert with a number of HIV/AIDS initiatives by other national and international aid organizations across Uganda. This program covers several sectors and includes resources for community-led activities to fight the disease, as well as assistance for acquiring antiretroviral drugs.

Coordinating the activities of government agencies and donors in the fight against HIV/AIDS remains a challenge, and a new Partnership Committee has been established to take on this task.

The HIV/AIDS programs are paying off. The proportion of adults with HIV/AIDS fell to 5 percent in 2001 from 8 percent in 1999. Most of the decline was among 15-to-24 year-olds.

The most difficult challenge remains changing community attitudes and entrenched behavior, not just in Uganda but in many countries confronting the disease. The discussion of sexual matters is often inhibited by fear, stigma, and social tradition.