World Bank Press Release - September 16, 2003

"By acting now and mobilizing greater political commitment at the country level, governments and development partners could stave off major crises that would damage health as well as economic growth, the labor force and the welfare of households," said Shigeo Katsu, Vice President for the Europe and Central Asia Region (ECA).

Over 1.2 million people are estimated to be living with HIV and AIDS in the region, with major variations across the 28 countries in the group. New HIV cases are growing faster in ECA than in any other region and must be considered alongside existing epidemics of injecting drug use, sexually transmitted infections (STIs) and tuberculosis (TB). Young people are hardest hit, a matter of particular concern due to structural vulnerabilities and factors that put them at risk of infection.

The report presents how the Bank is approaching the problem in the region (see box), describes the scope of the epidemic, and examines financial as well as sociopolitical and institutional constraints that impede success in fighting HIV/AIDS in ECA.

The cost of inaction

If the HIV epidemic becomes generalized among economically active age groups, annual economic growth rates could decline by 0.5 to 1.0 percentage points. In addition, health expenditures could increase by 1-3 percent. Furthermore, the dependency ratio (the ratio of non-economically active to economically active people) could rise, straining social protection systems, especially in such countries as Belarus, Moldova and Russia, where fertility rates are already dropping.

Knowledge and prevention matter, as does sustainable care of good quality

"Countries are paying more attention to the problem, but most of the current efforts to curb HIV/AIDS in the region are too small to have an effect on the course of the epidemic," notes Olusoji Adeyi, Lead Health Specialist in the ECA Region of the World Bank and lead author of the Regional Strategy. "Large-scale programs for HIV/AIDS prevention and care will require that funding from all sources increase from about $300 million in 2001 to about $1.5 billion by 2007. But money alone is not the issue. It is crucial to improve the local information base for programs, to support what works against HIV/AIDS, and to break down the barriers to effective actions in the region."

The regional strategy commits the World Bank to supporting greater political and social commitment to fighting the epidemics of HIV/AIDS and TB in the region. It stresses the need to generate and use essential information in program design, implementation and evaluation, including: epidemiological and behavioral surveillance as the basis for effective prevention; estimations of the economic and social impacts of HIV/AIDS and TB; how to get the best value for money and estimates of resource requirements for prevention and treatment.

The report pays particular attention to the prevention of HIV infection. Key factors in prevention include blood safety, harm reduction among injecting drug users, programs to prevent HIV transmission among sex workers and their clients, as well as interventions among prison inmates and ex-inmates, who are among the hardest-hit in the region. The authors call for ensuring sustainable, good-quality care for those infected with HIV, and the control of a dual tuberculosis-HIV epidemic. The Bank will support country-led preparations and implementation of large-scale programs to curb HIV/AIDS and tuberculosis.

The World Bank's support

The Bank works as part of a global coalition against HIV/AIDS. It is a cosponsor of the Joint United Nations Program on HIV/AIDS (UNAIDS) and a trustee of the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM). The Bank works in partnership with governments, NGOs, bilateral organizations, and multilateral agencies to support country- and regional-level responses to HIV/AIDS.

The World Bank is already active in the fight against HIV/AIDS in Eastern Europe and Central Asia. It has completed subregional studies on HIV/AIDS in Poland and the Baltic States as well as in Southeastern Europe, and a subregional study is underway in Central Asia. The Georgia HIV/AIDS country study was completed in 2003. Also in 2003 the Bank co-financed, with the UNAIDS Secretariat, a study of the region. The Bank is also co-financing, with the UNAIDS Secretariat, development of a directory of technical and managerial HIVAIDS resources, which will help countries gain better access to good-quality technical assistance.

HIV/AIDS lending operations are at various stages of preparation or implementation in Belarus, the Russian Federation, and Ukraine, and a grant from the International Development Association will support an AIDS control project in Moldova. HIV/AIDS control is included in the Poverty Reduction Support Credit in Albania. In the Russian Federation, the Bank has helped develop models and estimates of the potential economic impact of the epidemic, with the aim of informing discussions among decisionmakers. Economic analyses have also been undertaken in several other countries as integral parts of lending operations.

Next steps

"This document reflects our contribution to a larger effort that is supported by many partner agencies in the Region," says Debrework Zewdie, Director of the Bank's Global HIV/AIDS Program. "Knowledge of the dynamics of the HIV/AIDS epidemic in Eastern Europe and Central Asia will continue to increase. That growing knowledge base will be useful in tackling the epidemic. The Bank's Regional Support Strategy will be updated as more is learned about the epidemic and how to respond to it."

For more on HIV/AIDS in Europe and Central Asia, please visit: http://www.worldbank.org/eca/aids

Contacts:

In Washington: Merrell Tuck-Primdahl (202) 473-9516

mtuckprimdahl@worldbank.org

In Moscow: Marina Vasilieva (+7095) 745 7000 ext.2045

mvasilieva@worldbank.org

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