Barbados Responds Effectively to HIV/AIDS

Challenge

At the time of appraisal, the Caribbean had the highest HIV prevalence rate among adults outside Sub-Saharan Africa. In Barbados, the rate was 1.5% (2005), and the National Strategic Plan of Barbados 2005-2025 identified HIV/AIDS as one of the major threats to its overall success as it endangered the country's human capital. The First HIV/AIDS Project in the country achieved high levels of awareness, treatment, and care, but was less successful in inducing the level of sustained behavior change required to impact the epidemic's prevention and control. For example, knowledge among youth on sexual relations as a way of transmitting HIV was at 95% but condom use rates were only 21% among that subpopulation. 

Solution

To address these challenges, Barbados drew on World Bank funding for a follow-up project aimed at supporting the implementation of their National Strategic Plan. This follow-on project (The Barbados Second HIV/AIDS Project) was designed to encourage adoption of safe behaviors and increase access to prevention, treatment and social care, particularly for key high-risk populations. The Project also focused on organizational and institutional capacity building, as well as improvement in utilization of quality data. The use of disbursement-linked indicators ensured a focus on results and allowed for the development of the first HIS system in the country, which benefited the entire population and improved data collection going forward.

Results

The Barbados Second HIV/AIDS Project aimed to support implementation of the National Strategic Plan and to provide institutional strengthening via training and technical assistance. In line with support in these areas, the following key outcomes were achieved:

• Percentage of young men and women aged 15-24 years reporting the use of a condom the last time they had sex with non-marital non-cohabitating sexual partner went from 21% (2006) to 72% (2014);
• Percent of young women and men aged 15-24 who have had sexual intercourse before the age of 15 decreased from 20% (2006) to 12% (2014);
• Percentage of people living with HIV on first line antiretroviral regimen achieving virologic success within the first six months of treatment went from 60% (2008) to 93% (2014);
• Percentage of MSM who received an HIV test in the last 12 months and who know their results doubled from 50% (2009) to 100% (2014).

Bank Group Contribution

The proposed Project size was originally US$94.39 million, which included an IBRD loan of US$35 million. IBRD funding provided budget support for 35% of investment and operational costs (US$89 million) and financed 80% of technical assistance costs (US$4.5 million). Due to challenges in government financing in the wake of the global financial crisis, the total Project cost was US$72.2 million, with the IBRD loan size unchanged.  

Partners

The main implementing agency was the National HIV/AIDS Commission (NHAC), with support from the Ministry of Health. Additional partners in the region provided financial and technical assistance to address the issue of HIV/AIDS in the country while the Pan American Health Organization (PAHO) provided vital assistance during the midterm review. In addition, there was close collaboration with CSOs over the course of the Project. The number of CSOs working with key populations went from 2 to 38 over the course of the Project, and over 25 subprojects were fully implemented by CSOs at the time of Project closing.

Moving Forward 

The Project strengthened overall capacity, improved the multisectoral response and advanced monitoring and evaluation efforts, increasing the likelihood of technical sustainability. The NHAC has developed an evidence-based Strategic Plan for 2014-2018 and is expected to continue its work going forward. It recently presented its budget to the Cabinet, which is thought to be sufficient to continue prevention, treatment, and care efforts that were previously made through the Project. 

Beneficiaries 

Main beneficiaries of the Project were youth, Men who Have Sex with Men (MSM), and Female Sex Workers (FSW). Youth was the largest beneficiary group targeted at roughly 12.3% of the total population, while the size of the MSM and Sex Worker populations were 1% and 0.6-2.24% respectively. In addition, the Project also had spillover effects on the general population as a result of improvements made in the health information systems.