Foreword

HIV/AIDS has spread with ferocious speed. Nearly 34 million people in the world are currently living with HIV/AIDS, one-third of whom are young people between the ages of 10 and 24. The epidemic continues to grow, as 16,000 people worldwide become newly infected each day. AIDS already accounts for 9 percent of adult deaths from infectious disease in the developing world, a share that is expected to quadruple by 2020.

Nowhere has the impact of HIV/AIDS been more severe than Sub-Saharan Africa. All but unknown a generation ago, today it poses the foremost threat to development in the region. By any measure, and at all levels, its impact is simply staggering:

· At the regional level, more than 11 million Africans have already died, and another 22 million are now living with HIV/AIDS. That is two-thirds of all the cases presently on earth.

· At the national level, the 21 countries with the highest HIV prevalence are in Africa. In Botswana and Zimbabwe, one in four adults is infected. In at least 10 other African countries, prevalence rates among adults exceed 10 percent.

· At the individual level, the arithmetic of risk is horrific. A child born in Zambia or Zimbabwe today is more likely than not to die of AIDS. In many other African countries, the lifetime risk of dying of AIDS is greater than one in three.

In short, as a result of the HIV/AIDS epidemic, much of Africa will enter the 21st century watching the gains of the 20th evaporate.

Tragically, mass killers are nothing new in Africa. Malaria still claims about as many African lives as AIDS, and preventable childhood diseases kill millions of others. What sets AIDS apart, however, is its unprecedented impact on regional development. Because it kills so many adults in the prime of their working and parenting lives, it decimates the workforce, fractures and impoverishes families, orphans millions, and shreds the fabric of communities. The costs it imposes force countries to make heartbreaking choices between today's and future lives, and between health and dozens of other vital investments for development. Given these realities, African governments and their partners must act now to prevent further HIV infections and to care for and support the millions of Africans already infected and affected.

The World Bank can and will play a stronger role in this effort. This document, Intensifying Action Against HIV/AIDS in Africa: Responding to a Development Crisis, introduces the Bank's new strategy to combat the epidemic in partnership with African governments and the Joint United Nations Programme on HIV/AIDS (UNAIDS). The strategy, approved by the Regional Leadership Team in May 1999, stands on four pillars:

· Advocacy to position HIV/AIDS as a central development issue and to increase and sustain an intensified response.

· Increased resources and technical support for African partners and Bank country teams to mainstream HIV/AIDS activities in all sectors.

· Prevention efforts targeted to both general and specific audiences, and activities to enhance HIV/AIDS treatment and care.

· Expanded knowledge base to help countries design and manage prevention, care, and treatment programs based on epidemic trends, impact forecasts, and identified best practices.

(An ideal national program that incorporates these four pillars is presented as a case study in Annex 1.)

To stimulate and support implementation of the strategy, the Bank has established a multisectoral AIDS Campaign Team for Africa (ACTafrica), which will be based in the Office of the Regional Vice Presidents. The high-level placement of ACTafrica underscores the Bank's commitment to HIV/AIDS prevention and care and will enable the team to maximize collaboration among the sector families. Most of ACTafrica's work will be demand-driven and funded from country budgets. The team will serve as the region's focal point and clearinghouse on HIV/AIDS and will provide a variety of services, including:

· Equipping and supporting Bank country teams to mobilize African leaders, civil society, and the private sector to intensify action against HIV/AIDS.

· Retrofitting projects with HIV/AIDS components where possible, assisting in the development of new dedicated HIV/AIDS projects, and building AIDS-mitigation measures into other projects where necessary.

· Supporting Bank country teams in addressing HIV/AIDS in their country assistance strategies.

· Exploring the feasibility of building an AIDS impact assessment module into existing environmental and/or social assessment processes.

· Collecting and disseminating information on the progress of the epidemics, country-by-country statistics, and best practices.

· Strengthening and expanding the Bank's partnership with UNAIDS, as well as with key agencies, nongovernmental organizations, and interested bilaterals.

The strategic plan detailed herein represents the Bank's next important step in the fight against HIV/AIDS in Africa. By its terms, we will now place HIV/AIDS at the center of our development agenda, and mainstream it in all aspects of our work in Africa and in all channels of our dialogue. We will help our clients intensify and expand their national responses and help build capacity among our staff in all sectors to factor HIV/AIDS into policies and projects. We will establish HIV/AIDS as both a corporate priority and our primary partnership issue. Finally, we will ensure that Sub-Saharan Africa realizes the full potential of our strategic partnership with UNAIDS.

It is easy to despair of AIDS. But let us bear in mind the many formidable challenges that Africa has already faced and overcome: wars of independence, global economic upheaval, droughts, floods. Then let us remember that unlike any of these, AIDS is completely preventable.

Recently, a history of the World Bank's first 50 years was published. In its more than 1,900 pages, including a 100-page chapter on Africa, the word "AIDS" barely appears. A generation from now, when the next such history is written, we can be certain that the pandemic will play a far more prominent role. Those who look back on this era will judge our institution in large measure by whether we recognized this wildfire that is raging across Africa for the development threat that it is, and did our utmost to put it out. They will be right to do so.

Let's get to work.

CALLISTO MADAVO
JEAN-LOUIS SARBIB

VICE PRESIDENTS
AFRICA REGION

JUNE 1999