“Ending AIDS and Poverty”
Your Excellencies and honored guests, ladies and gentlemen, colleagues and friends,
As we look back on the history of this epidemic, it is hard to say that there is any one moment when the tide began to turn. Because the truth is that we have been turning back the tide of AIDS, step by painful step, for 30 years.
And at nearly every turn, it is the activists, and their communities, that have led the way.
It was activists and communities who devised safer sex, promoted condom use, needle exchange and virtually all the behavioral prevention we use today.
It was activists who transformed drug development and regulatory processes, and involved patients in clinical research, cutting drug approval times in half in the global north.
It was activists in Durban in 2000 who began to push for access to antiretrovirals in the developing world and who kept pushing and are pushing still for them to be affordable and available to everyone who needs them, everywhere.
And it was activists whose deep understanding of the communities most affected by AIDS has spurred a movement to promote the health and dignity of gay men, sex workers and drug users that has now reached every corner of the world.
It was TASO in Uganda, ACT UP in the US, TAC in South Africa, Grupo Pela Vida in Brazil, the Lawyers Collective in India, the Thai Drug Users Network, and countless organizations like them that have woven together one of the most extraordinary movements the world has ever seen.
Remember what ACT UP stands for: the AIDS Coalition to Unleash Power.
This has been a movement that came together in anger, that thirsts for justice, that is fundamentally about unleashing the power of human solidarity, and that for 30 years has forged alliances to expand that solidarity and be ever more inclusive.
A movement that has grown to include pioneering governments from Brazil to Botswana, UN agencies, visionary donors and donor countries, and groundbreaking NGO treatment programs; a movement that has led to efforts such as 3 by 5 and the creation of the Global Fund and PEPFAR.
Thanks to this collective effort, we have seen remarkable gains in the fight. Prevalence has fallen steeply in many countries, new prevention strategies show great promise, and more than 8 million people are on treatment today.
As we gather here in Washington, we look towards the end of AIDS as something that is actually within our reach, a vision that to me and many others here seems less idealistic, less outrageous, than 3 by 5 did, just a decade ago.
Today marks the first time that a President of the World Bank Group has addressed the International AIDS Conference. I’m here because I know what this movement is capable of achieving. I’m here to bring you both a pledge and a challenge.
I pledge that the World Bank will work tirelessly with all of you here to drive the AIDS fight forward until we win.
And I challenge you to join me in harnessing the moral power and practical lessons that the AIDS movement has produced to speed progress against that other global scourge, poverty.
As the leading global development institution, the World Bank is concerned with all aspects of development, all the dimensions that are united in the eight Millennium Development Goals. We know that development challenges are interdependent. And yet our approaches to these problems often remain fragmented, limiting our vision and our results. That’s why the idea of bringing lessons from AIDS to poverty reduction is crucial. By breaking down siloes between these two efforts, we begin a process that will go much farther. Ultimately we’ll multiply the flows of knowledge and experience across all development sectors, accelerating progress on education for all, maternal and child health, environmental sustainability, and so many of our other goals.
Let me describe how the World Bank is applying its distinctive strengths to AIDS.
The World Bank’s mission is to build prosperity and eradicate poverty in countries around the world. The Bank supports countries with financing, but also with knowledge and analytic capacities that are often just as important.
In 2000, under President Jim Wolfensohn, the World Bank worked with many of you here to put the first billion dollars on the table for AIDS. Today, in health, the World Bank’s comparative advantage is in systems building. Our health sector strategy is focused on supporting countries to create health systems that deliver results for the poor and that are sustainable. We also help countries build social protection systems that can mitigate the impact of events like economic shocks and catastrophic illness, including AIDS, on families and communities.
As an example of our health systems work, the World Bank is helping governments implement performance-based financing, which gives local health facilities financial rewards when they increase delivery of essential services and improve quality. In Burundi, after a performance-based financing model was introduced nationally to strengthen the AIDS response, the number of HIV-positive pregnant women receiving antiretrovirals for the prevention of mother-to-child transmission increased by 65 percent in just one year.
We know that HIV is more than a medical problem. AIDS has devastating economic and social impacts on individuals, families and communities. That’s why social protection is also a critical piece of a comprehensive AIDS response. Every year, worldwide, 150 million people are forced into poverty by increased health expenditures and lost income due to illness, including AIDS. To date, the Bank has helped 40 countries scale up social safety-net programs, including health insurance schemes, old age pensions and cash transfer programs that supplement the incomes of poor families. Our goal is for all countries to be able to implement basic social protection programs tailored to their specific needs.
Success in the AIDS response depends on partnerships. On a very personal level, I am committed to strengthening the World Bank’s multilateral alliances with UNAIDS and the Global Fund; our partnerships with UN technical agencies, including WHO and UNICEF; and our collaboration with PEPFAR and other bilaterals. Moreover, strong partnership with civil society that delivers results for the poor will be a signature of my presidency. We’ll build on the lessons of the Bank’s MAP initiative, which recognized that civil society voice is critical to make programs work for poor and vulnerable people.
In 2008, the overall proportion of people in the developing world living on less than $1.25 per day was 22 percent, less than half of the 1990 figure. The Millennium Development Goal of halving the incidence of extreme poverty has been reached. But today 1.3 billion of the world’s people still live in absolute poverty. This is intolerable. We can and must end absolute poverty in our lifetime. To do so, we’ll need to share know-how across the boundaries of institutions and development fields. And we’ll need to use that know-how to build systems that can sustainably meet human needs.
The AIDS fight has shown the world how to turn the tide of a massive assault on human life and dignity. We have a responsibility to ensure that lessons from AIDS inform and improve our efforts to tackle other social goals, above all poverty eradication.
In some places, this is already happening. Governments and their partners are applying AIDS knowledge and resources strategically to beat the epidemic and simultaneously drive a broader anti-poverty agenda. Rwanda has used AIDS money and technical expertise from the World Bank, the Global Fund and others to build up its widely admired health insurance system, the mutuelles, and to expand secondary and vocational education. In Rwanda, AIDS resources are contributing to the strategic investment in human capital that has helped drive the country’s remarkable economic progress. From being an exception, this approach can become the rule. This will be a leap forward in our capacity to build systems and deliver results.
As Rwanda shows, successful countries have tackled AIDS as a systems problem. They’ve responded to the epidemic by strengthening delivery systems for key social goods, and they’ve integrated those systems to address people’s needs comprehensively.
Building systems is what the World Bank does best. We have decades of experience making systems work for all, but especially the poor. I want the Bank to lead the world in joining systems knowledge with clear moral values to help countries solve their toughest problems.
Two features of the AIDS fight with clear lessons for poverty work are openness and innovation. The countries that have achieved the greatest successes against AIDS have been open about their epidemics. They have shared information widely, challenged stigma, and encouraged public debate. They have refused secrecy and dispelled irrational fear. There are many lessons here for the way we fight poverty. As we at the World Bank continue to tackle corruption, increase transparency and freely share our data, we’re taking these lessons from the AIDS fight ever more fully on board.
Looking back over the last 30 years, we see that the AIDS response has generated continuous innovation. From the acceleration of drug approval protocols to task shifting within medical teams. From fixed-dose drug combinations to the hiring of accompagnateurs to deliver community-based services.
We’ll need more innovation in the years ahead to finish the fight against AIDS. As President of the World Bank, I want to infuse that same appetite for innovation into the struggle for inclusive economic development. I’m convinced that if the practical know-how and the spirit of the AIDS movement can be brought to the poverty fight, there is no limit to what we can achieve.
On the front lines of the 3 by 5 initiative, I saw daily how HIV implementers were generating innovative solutions to practical problems: from supply chain management to human resources to creating space for community voice in program evaluation. But have we done enough to organize, analyze and apply this knowledge? Have we brought it to bear in every setting where it could be transformative?
All of us here know that a difficult fight against HIV lies ahead. We have come to Washington because we are determined to win that fight. We see our task through the lens of solidarity that has inspired the most ambitious AIDS activism and that we all feel today in this room. From the start, as they fought this epidemic, the activist pioneers knew they had to tackle the structural forces of prejudice, social exclusion and economic injustice. Their ambition to end unjust human suffering was as vast as the suffering itself. All of us here today must be just as ambitious.
The AIDS movement has rekindled values that show the kind of global development we’re striving for: development grounded in solidarity, courage, respect for the dignity of all people, and an unrelenting demand for justice.
If we unleash the power of these values, we can overcome any obstacle in the fight for economic and social justice. If we unleash the power of these values, we can leave to our children a world free of poverty and AIDS.
We can end AIDS. We must end AIDS. The challenge we face is great. But as I look out at all of you today, I can actually see the end of AIDS.
Thank you, let’s make it happen.