World Bank Press Release - October 14, 2003

In report on the subject released today at the Third Central American Congress on Sexually Transmitted Diseases/HIV/AIDS, Concasida 2003, which runs from October 13-17 in Panama city, the World Bank indicated that Belize, Honduras, Panama, and Guatemala are four of the six countries with the highest HIV prevalence in all of Latin America as of the end of 2001.

"The HIV/AIDS epidemic in Central America is serious and is worsening, and although the epidemic continues to be concentrated in high risk populations, it has become generalized in some countries," said Jane Armitage, the World Bank's Director for Central America. "Fortunately, there is still time to limit the current and future impact of HIV/AIDS. Prevention is the key."

According to the document titled HIV/AIDS in Central America: An Overview of the Epidemic and Priorities for Prevention, HIV adult prevalence is highest in Belize (2 percent), followed by Honduras (1.6 percent), Panama (1.5 percent), Guatemala (1 percent), El Salvador (0.6 percent), Costa Rica (0.6 percent), and Nicaragua (0.2 percent), based on UNAIDS estimates.

HIV transmission in Central America is primarily due to heterosexual sex, which is more similar to the Caribbean than the South American pattern, and although there are more men than women with AIDS in Central America, the gender gap is closing, according to HIV/AIDS in Central America: An Overview of the Epidemic and Priorities for Prevention.

The epidemic is generally concentrated in high-risk populations such as men who have sex with men, commercial sex workers, prisoners, the Garifuna (an Afro-Caribbean population group), and in the case of Honduras, street children and the security forces. However, the World Bank makes it clear that there are significant exceptions: the disease is becoming generalized in some areas of Belize and the epidemic can still be classified as nascent in Nicaragua.

As for El Salvador, Guatemala and Panama, the projections indicate that if the current pattern continues the epidemic could reach adult prevalence levels of close to 2% in those countries by the year 2010.

"Some countries have active policies to combat and prevent the disease, such as free condom distribution to high-risk groups," said Helena Ribe, the World Bank's Sector Leader for Human Development in Central America. "But these initiatives must be improved and expanded, and government spending needs to focus more on prevention activities."

According to the Allocation by Cost-Effectiveness Model developed by the World Bank to help responsible officials determine the resource allocation that will prevent the maximum number of new infections, a substantial impact on the epidemic can be achieved even with limited resources, provided these are channeled to the most cost-effective interventions.

"Even with limited resources a substantial impact on the epidemic can be achieved, but current funding allocated to HIV prevention in Central America is far from adequate," said Helen Saxenian, the World Bank's Lead Economist for Health in Latin America and the Caribbean. "In order to prevent between 10% and 20% of new infections, countries must invest at least US$1 million each year in highly cost-effective prevention activities."

HIV/AIDS in Central America: An Overview of the Epidemic and Priorities for Prevention also finds that in Central America this minimum prevention package should include free condom distribution to high-risk groups, condom social marketing, information, education and communication for high-risk groups, and counseling and access to rapid testing.

In 2000, total (public and private) financing allocated to public health and HIV prevention activities was US$6 million in Honduras, US$800,000 in Panama and US$2.8 million in Guatemala - the countries in which the model has been applied - although, according to the document, these funds did not have a strong focus on high-impact prevention activities.

Contacts: Alejandra Viveros (202)473-4306 Aviveros@worldbank.org

Lee Morrison (202)458-8741 - Lmorrison1@worldbank.org

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