HIV/AIDS and the World Bank

21 November 2005 | Inside the institutions

The Bank states that as of the end of 2004, 39 million people worldwide were living with HIV/AIDS, of which more than 95 per cent were in low- and middle-income countries. Nearly two-thirds are in sub-Saharan Africa, and nearly one in five in South or Southeast Asia.

The World Bank has been carrying out efforts to prevent HIV/AIDS and mitigate its impact since the late 1980s. Most efforts have been over the last decade: only 9 free-standing AIDS projects and 22 with AIDS components of at least $1 million have been completed. Nearly two thirds of its global projects and commitments have been launched since 2000, the majority of which are accounted for in the Africa Multi-Country AIDs Programme (MAP). The Bank, now one of the main sources of funding for HIV, committed $2.46 billion in credits, grants and loans to 62 low and middle-income countries for 106 projects to prevent, treat and mitigate the impact of HIV/AIDS, as of June 2004. $1 billion of this has so far been disbursed. The Bank is also a trustee of the Global Fund to Fight AIDS, Tuberculosis and Malaria, for which it currently holds $2.2 billion in a trust fund.

There have been two phases to the Bank’s response to HIV/AIDS: from 1986-1997, and 1998 onwards. The first phase was constrained externally by low demand for HIV/AIDS assistance from developing countries, and internally by the focus of the Bank’s health sector leadership on health system reforms. Hence, investment in prevention was not prioritised. Even in 1997, the Bank’s health, nutrition and population (HNP) strategy contained no discussion of the AIDS epidemic. Initiatives during this phase to provide approximately $500 million in loans and credits for national AIDS programmes came largely from individual health staff rather than the Bank’s HNP leadership or top-level management.

The Bank's work in HIV/AIDS is central to its poverty reduction mandate

The transition to the second phase was marked by a number of events in 1996-97: the creation of the joint United Nations programme on HIV/AIDS (UNAIDS), of which the Bank is now one of eight co-sponsors, which influenced Bank management to act; the Bank’s publication of a major research report highlighting AIDS as a development issue; and the development of effective anti-retroviral therapy.

Since 1998 HIV/AIDS strategies have been completed in nearly all geographic groupings of the Bank, and an additional $2 billion has been committed to support national HIV/AIDS programmes in 55 countries at all stages of the epidemic. Roughly half of the new commitments since 1998 have been through more than two dozen projects of the MAP.

Africa Multi-Country HIV/AIDS Programme

The Africa MAP, which started in 2000, signalled the start of a 10-15 year commitment by the Bank. Its projects, which are all still on-going, account for about two thirds of the Bank’s active HIV/AIDS projects globally. From September 2000 to June 2004, 29 country-level Africa MAP projects were approved, amounting to roughly $1 billion in commitments, of which about $255 million had been disbursed. The programme comes mainly from IDA grants or concessionary loans. Its objectives are to: scale up prevention, care, support and treatment programmes; and prepare countries to cope with the impact of those who develop AIDS over the next decade. The eligibility criteria for countries wishing to participate in the Africa MAP are as follows:

  • Evidence of a strategic approach to HIV/AIDS, developed in a participatory manner;
  • existence of a high-level multi-stakeholder HIV/AIDS coordinating body, including people living with AIDS;
  • government commitment to quick implementation arrangements, including channelling grant funds directly to communities, civil society and the private sector; and
  • agreement by the government to work with different agencies, especially civil society.

The MAP programme relies heavily on the technical and strategic guidance of each countries national and strategic plan. It also requires much stronger monitoring and evaluation than standard project supervision.