US$100M in World Bank funds likely for Caribbean HIV/AIDS programmes

Stabroek News
September 14, 2000

The World Bank is moving to request that its executive directors approve US$85 million - US$100 million in loans and credits for HIV/AIDS reduction programmes in the Caribbean.

The announcement was made by Vice-President David de Ferranti while addressing the opening on Monday of a two-day high-level meeting in Barbados of country delegations and international organisations, cosponsored by the Government of Barbados, CARICOM, PAHO/WHO, UNAIDS and the World Bank.

According to the World Bank's website, the bank's intervention would build upon existing programmes in the Caribbean and support the Caribbean Regional Strategic Plan of Action for HIV/AIDS, put forth by the Caribbean Community (CARICOM).

"Caribbean countries must take the lead, and the international community must work together to support the region in this effort," said de Ferranti, stressing that prevention efforts were critical and must be complimented by treatment and care for those affected by HIV/AIDS. "Because there is no cure and because treatment is out of reach for many, we must be serious about prevention. We also must remember that treatment is a critical part of a comprehensive approach. It is just as important to prolong and care for the lives of those who are already HIV positive or dying of AIDS, as it is to protect those without it."

During the opening session, Barbados' Prime Minister Owen Arthur, announced that his country's national HIV/AIDS coordination agency would be located in the Prime Minister's office.

"Caribbean leaders have recognised the gravity of the AIDS epidemic and are prepared to fight it," said World Bank Director for the Caribbean, Orsalia Kalantzopoulos. "The participation of Prime Ministers from Barbados, Bahamas, St Kitts-Nevis, and St Vincent and the Grenadines shows that this is now accepted as a critical development priority, one that encompasses much more than health issues, but also social and economic ones."

If approved by the bank's Board of Directors, the bank's support would be available as soon as a country was ready to use it effectively, covering a period of four to five years, the website said.

"We believe that the bank's assistance would be most useful when applied to financing a share of a well-planned and coherent national HIV/AIDS programme," said Christopher Lovelace, director of Health, Nutrition, and Population, at the World Bank. "By this we mean a programme that aims, over a period of between three to four years, to address the priorities set in the regional strategic plan of action, and sets realistic targets for reducing the rate of new infections, raises the quality and coverage of care, and builds institutional strength to sustain gains over the longer term." He added that the bank's assistance would need to be well-coordinated with that of other donors and the NGO community to cover the range of various costs for the national programmes.

The Caribbean region now has the highest HIV prevalence rate of any region in the world apart from sub-Saharan Africa. Recent evidence suggests that there are over 360,000 people living with HIV/AIDS in the Caribbean today, although the number may be as high as 500,000 due to under-reporting. At the end of 1999, over 80,000 children in the region had been orphaned by AIDS.

In the most affected parts of the region, HIV/AIDS estimates reach as high as 12% in urban areas and five per cent in rural areas. In many countries, the pandemic has spread beyond the high-risk population to the general population. Once the prevalence rate in the general population reaches around five per cent, the virus spreads rapidly. When and if that happens, the pandemic reverses the hard-won gains in development and causes turmoil more devastating than any natural disaster.

The University of the West Indies, in a study with UNAIDS and the World Bank, estimates that effective HIV/AIDS prevention efforts, plus basic care and treatment for patients suffering from AIDS, would be in the order of US$260 million per year for the Caribbean region.

The cost for retroviral treatment for each new case of HIV/AIDS would be significantly higher. At current prices, each case prevented eliminates US$7,000 - US$8,000 per year in treatment costs and significantly reduces the spread of the virus, and future suffering. Meanwhile, UNAIDS and its joint co-sponsors are working with the pharmaceutical industry to see if those costs can be significantly reduced.

To date, the World Bank has dedicated over US$1 billion for 99 HIV/AIDS-related projects in 56 countries. The bank has three projects in the Latin America and Caribbean region that support HIV/AIDS programmes. A US$160 million project in Brazil is devoted entirely to prevention and treatment for AIDS and sexually transmitted diseases; and two other projects, one in Haiti and one in Argentina, have HIV/AIDS components, bringing the total regional commitment to just over US$200 million.

The bank is a co-sponsor of UNAIDS and also supports two major global vaccine initiatives-the International AIDS Vaccine Initiative, and the Global Alliance on Vaccines and Immunization (GAVI), the website said. An AIDS Vaccine Task Force has worked with the AIDS Vaccine Initiative over the past 18 months to look at ways to promote research and development of an effective vaccine, and has been actively consulting with partners on strategies to accelerate development of this and other public goods, while GAVI has as its purpose ensuring that all children are protected from vaccine-preventable diseases.

The bank has pledged to substantially expand the financial resources it makes available to programmes specifically to combat HIV/ AIDS and other communicable diseases. Toward this end, it will initially make US$1 billion in concessional resources available worldwide, and it is prepared to move well beyond that level in the future, as national and regional programmes are developed.

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