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Monday, June 19, 2006 

AIDS Regional Update: Latin America & the Caribbean


In the past 20 years, around 600,000 people in the Latin America and Caribbean (LAC), region have died from AIDS. Today, two million people live with HIV/AIDS and approximately 567 contract the HIV virus every day. As in other developing regions, HIV/AIDS disproportionately affects LAC countries’ most productive workers, infecting about one in 20 adults between the ages of 15 and 49.

The impact of HIV/AIDS is especially pronounced in the Caribbean, where the prevalence of the virus in the adult population is estimated at 2.3 percent - the highest rate in adults outside Sub-Saharan Africa where the epidemic has hit hardest. HIV/AIDS is the leading cause of death among men under the age of 45 in the Caribbean and more than 250,000 children have been orphaned by the epidemic.

What is fueling the epidemic in LAC countries? The following are some factors that have contributed to the spread of HIV/AIDS:

° Risky behaviors ranging from unprotected sexual contact, needle sharing, multiple partners, early start of sexual relations, migration and mobility.
° Political and economic instability threatens the response to HIV. Frequent turn over of human resources leads to lack of institutional memory and capacity. An economic crisis often triggers a reduction in social expenditures, which can lead to limited national resources for HIV, while a political crisis can lead to weakened and interrupted responses.
° Stigma and discrimination, can lead to a lack of social response which can facilitate the spread of the epidemic.
° Lack of implementation capacity can undermine the effectiveness of programs designed to combat HIV/AIDS, or provide treatment to those living with AIDS.
The World Bank’s Response

The World Bank is working closely with the region's governments, civil society, and other international organizations to provide critical financial and analytical resources to counter the spread of HIV/AIDS and provide treatment and care for people affected by the epidemic.

The participation of civil society in the fight against the epidemic is a key pillar of all Bank-financed projects because they have proved to be effective in working with vulnerable, and high-risk groups that are often hard to reach through traditional institutions.
Over US$550 million had been committed by September 2003 in Latin America and the Caribbean to help finance the implementation of HIV/AIDS prevention and control programs in Argentina, Barbados, Brazil, Dominican Republic, El Salvador, Grenada, Guyana, Haiti, Honduras, Jamaica, Mexico, Trinidad and Tobago, St. Kitts and Nevis, and Venezuela. Projects for St. Vincent and the Grenadines and Saint Lucia are expected to be approved by the end of July, 2004.

Beyond financial assistance, the World Bank has produced a variety of research on the impact of HIV/AIDS in the region. In October, the Bank prepared the report, HIV/AIDS in Central America: An Overview of the Epidemic and Priorities for Prevention , for the Concasida conference in Panama City. In November, 2003, the Bank released the report HIV/AIDS in Latin American Countries: The Challenges Ahead to facilitate the implementation of prevention and control strategies that are tailored to the needs of both the region and specific countries.Bank staff are also keen to learn from the experience of government leaders, civil society organizations, and multilateral development partners. To this end, Bank health specialists and management frequently participate in HIV/AIDS-related conferences. In July 2003, the Bank hosted a round-table meeting on Accelerating the Response to HIV/AIDS in the Caribbean ( available in streaming video ), which featured the Prime Minister of St. Kitts and Nevis, Dr. Denzil Douglas, among other bilateral and multilateral partners.
The Caribbean

The World Bank, as part of the US$155 million Multi-Country HIV/AIDS Prevention an Control Program (MAP) for the Caribbean, has made available loans/credits/grants to Barbados (2001), Dominican Republic (2001), Jamaica (2002), Grenada (2002), St Kitts and Nevis (2003), Trinidad and Tobago (2003), Pan Caribbean Partnership Against HIV/AIDS (2004), Guyana (2004). Projects for St. Lucia and St. Vincent and the Grenadines are expected to be approved by the end of July, 2004.

In addition, a US$2.9 million Post-Conflict Grant was approved in March 2003 for Haiti to help prevent and control infectious diseases, including HIV. The grant is being implemented with the support of the Pan-American Health Organization and the World Health Organization.
Since its inception in 2001, the US$155 million MAP program has substantially contributed to Caribbean countries’ fight against the HIV/AIDS epidemic.

In Barbados, the HIV/AIDS mortality rate fell by 43% after antiretroviral drugs became universally available in January 2002.

Since 2003, close to 1,500 people infected with HIV/AIDS in Trinidad and Tobago are now receiving Anti-retroviral (ARV) therapy.

In the Dominican Republic, more than 90% of provincial hospitals have implemented programs to prevent mother-to-child transmission of HIV/AIDS, covering close to 40,000 pregnant women and newborns in 2002.
Central America

In Central America, HIV/AIDS components were included in El Salvador's Earthquake Emergency Recovery and Health Service Project and the Health System Reform Project in Honduras.

South America

In response to the severe economic crisis of 2002, a total of US$88 million was reallocated from several loans for the purchase of anti-retroviral medications, allowing the government to continue ARV treatment for approximately 17,000 HIV infected people during that year.

The Brazil HIV/AIDS Program is recognized as an international best practice. In 1996, without relinquishing its preventive actions, Brazil was the first country to set up a program of ARV distribution aimed at providing access for all. Around 125,000 patients currently benefit from free ARVs through the public health system. Over the past seven years, there has been a significant reduction in mortality, morbidity and hospitalization.

Since 1996, it is estimated that the average survival time of affected people has risen from 6 months to 5 years.

The incidence of opportunistic infections has gone down by 60 to 80%, and patients' quality of life has improved significantly.

Since 1993, Brazil has reduced the number of AIDS related deaths by 50 percent.
It has been calculated that the savings for the Government in the short term exceeds US$1.1 billion just for the number of hospitalizations avoided, and US$2 billion if out-patient care is included.

The World Bank has been supporting HIV/AIDS projects in Brazil since 1988, when a US$109 million loan was approved to support an endemic disease control project. Over the past decade, the Bank has approved US$425 million in loans to finance three successive phases of the Brazil AIDS and Sexually Transmitted Diseases (STDs) Control Project. Although a US$100 million loan was approved in June, 2003 to finance the third phase of the Brazilian HIV/AIDS National Program, results from the first two phases are cause for optimism since they have financed 1,500 grassroots projects that have:

° Distributed over 480 million condoms;
° Raised AIDS awareness among over half-a-million people at risk;
° Supported a nation-wide network of 177 AIDS testing and counseling centers and 800 diagnostic and treatment clinics for sexually transmitted diseases;
° Established a partnership with the National Business AIDS Council to provide AIDS-awareness training in over 3,000 companies, benefiting around 3.5 million workers; and
° Trained 3,800 teachers and 32,500 students in promoting AIDS and drug abuse prevention.


As part of a World Bank-financed project, and at the request of the Mexican Government, in 2003 the World Bank provided technical assistance to the Federal Health Secretariat/National HIV/AIDS Council (SSA/CENSIDA) to optimize resource allocation for HIV Prevention in that country. The results were used as key inputs for the formulation of the Health Secretariat 2004 budget. In addition, a US$20 million is allocated under the Procedes Project to finance HIV/AIDS prevention and control activities, including treatment with ARV.

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