The World Bank was a leader in global HIV/AIDS financing in the early days of the emergency, and since 1989 has provided US$3 billion in International Development Association (IDA) financing, and US$914.72 million in International Bank for Reconstruction and Development (IBRD) financing. In fiscal year (FY) 2010, the Bank disbursed US$327 million to support HIV/AIDS-related activities for existing operations, and supported countries by filling critical gaps in AIDS prevention, care and treatment, and mitigation.
Most of the world’s 33.3 million people living with HIV/AIDS are in developing countries. In 2009, 2.6 million people became newly infected with HIV, and 1.8 million died of HIV-related illnesses. Sub-Saharan Africa accounted for 68 percent of all new infections. HIV/tuberculosis (TB) co-infection has recently emerged as a major challenge in Africa, particularly in Southern Africa, with TB the most cited cause of death among HIV-positive people. Even where overall HIV prevalence is low, AIDS can be a severe burden: It is the leading cause of premature death in Thailand and China. Although 5.2 million people are accessing treatment globally, 10 million in need do not have it. Moreover, for every one person on treatment, two are infected. Without effective HIV prevention, the numbers requiring treatment will become unsustainable.
Despite the increase in funding during the past decade—from US$1.6 billion in 2001 to US$15.6 billion 2008—financing gaps persist, and the bulk of likely available funds is unpredictable and mainly for treatment. As new infections rise, country and donor investments in prevention are not being sustained. Growth in investment for the AIDS response flattened for the first time in 2009, but demand remains intense: US$15.9 billion was available in 2009, US$10 billion short of the 2010 requirement. Nearly 90 percent of spending on AIDS is from international sources, and the bulk of the funding is jeopardized by tight donor and national government budgets, household income losses, and worsened food security.
The Bank’s approach has evolved with the changing HIV/AIDS landscape. The Bank emphasizes support to national strategic responses outlined in countries’ national HIV/AIDS strategic plans. Where possible, the Bank participates in the pooling of funds, and works closely with the Joint United Nations Programme on HIV/AIDS (UNAIDS) family and other partners to ensure more effective and efficient responses in regions and countries, consistent with the UNAIDS vision of zero new infections, zero AIDS-related deaths, and zero discrimination. The Bank responds to country needs within the context of Country Assistance Strategies, which take account of support from other partners and the governments’ funding for effective prevention of new HIV infections, care and treatment, and alleviation of social and economic consequences for affected communities. The Bank plays a global leadership role in HIV strategic planning; developing well-prioritized, evidence-based national AIDS strategies and action plans; preventing sexual transmission of HIV; and strengthening social protection for people affected by HIV. The Bank supports countries to improve the efficiency, effectiveness, and sustainability of national AIDS programs and works with stakeholders to improve the evidence around HIV prevention. The Bank also engages in key sectors such as education, transport, energy, and infrastructure, to bridge gaps in AIDS prevention, care and treatment, and mitigation.
IDA and IBRD-financed HIV/AIDS operations are designed and implemented with a particular emphasis on reaching Millennium Development Goal 6. IDA has financed 1,500 counseling and testing sites, ultimately HIV testing nearly 7 million people. It has funded more than 65,000 civil society HIV initiatives in Sub-Saharan Africa and has helped reduce HIV risk behavior among men and women aged 15-24. IDA has also educated 173 million people about HIV/AIDS and has mitigated the impact of AIDS for 1.8 million children and half a million adults through 38,000 grassroots initiatives. IDA was the first source of substantial funding for HIV/AIDS in Sub-Saharan Africa, the Caribbean, and India, and remains the most predictable, flexible, long-term financing source. IDA’s Multi-Country AIDS Program helped increase total resources for HIV in developing countries from US$300 million in 1996 to US$14 billion in 2008 (including domestic public and private spending).
In 1993, the IBRD first responded to HIV with a US$160 million loan to Brazil for an AIDS and Sexually Transmitted Disease Control Project. Brazil later received additional financing in three projects for a total of US$492 million, which together have strengthened Brazil’s exemplary country response. In Botswana, the IBRD has increased the coverage, efficiency, and sustainability of targeted HIV/AIDS interventions by focusing on institutional capacity building, prevention, and mitigation.
Today, with the large grant resources of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the U.S. President’s Emergency Plan for AIDS Relief, the Bank is no longer the major financier for AIDS, but remains a key source of support—continuing to strengthen national and sub-national capacity for planning, managing and monitoring HIV responses and thus enabling countries to use other sources of global funding more effectively. The Bank continues to finance specific country projects as well as use policy lending to strengthen these national HIV/AIDS responses.
The Bank plays a global leadership role and is a founding cosponsor of UNAIDS, and works closely with global partners in the UNAIDS family to deliver results. The Bank also helped create the Global Fund and serves on its board and as trustee. The Bank plays a strong role in promoting donor harmonization, coordination, and alignment.
In partnership with DFID, the Bank is evaluating community responses to HIV/AIDS to build evidence on the impact of specific activities and programs. The Bank is also working with the International AIDS Vaccine Initiative to support research on a vaccine to bring an end to the AIDS pandemic.
Toward the Future
The Bank continues to view HIV/AIDS as a fundamental development problem, focusing especially on HIV strategic planning, prevention, care, and treatment services, along with social protection for people affected by HIV.