AIDS prevention and mitigation in sub-Saharan Africa : an updated World Bank strategy

During the past decade more than 11 million adults and 1 million children have been infected with the human immunodeficiency virus (HIV) in Africa. Indeed, the Acquired Immunodeficiency Syndrome (AIDS) is taking a calamitous toll in human suffering, in reduced life expectancy and productivity, in disruption of social systems, and increased poverty in Africa. AIDS is now believed to be the leading cause of adult death between the ages of 15 and 39 in Malawi, Tanzania, Uganda, Zambia, and Zimbabwe. Just as striking have been the escalating deaths from AIDS of children under the age of five in the same countries. Thus many Africans are witnessing the reversal of gains made over the past 2 decades in adult and children survival. Despite the adverse effects caused by the epidemic, the response from governments, nongovernmental organizations and others is commendable, and examples of human valor and strength among African HIV-infected communities are numerous. Because sexual transmission is the predominant mode of HIV transmission, preventing the epidemic's further spread requires fundamental changes in individual and communities' sexual attitudes and practices. The means by which to affect change are: 1) education on safe behaviors; 2) promotion of condoms; and 3) improved treatment of the other sexually transmitted diseases. Of lesser importance in slowing the transmission but still a necessity, is ensuring that blood used in transfusions is safe from HIV contamination. In response to the ever-changing nature of the epidemic, this update is the second review of the World Bank's 1988 AIDS strategy for Africa. The first review, in 1992, found that the six strategy actions from 1988 concerning economic and sector work, lending and capacity-building had been initiated with progress. As the 1992 review identified new areas requiring attention, this review suggests some additional actions to assist Africans: 1) to generate greater political commitment to the Organization of African Unity declarations on AIDS; 2) to work more vigorously to change health behaviors; 3) to intensify national programs according to a typology of countries based on severity of prevalence levels; 4) to increase the analysis of AIDS and its impact on development goals in economic and sector work; and 5) to improve the design and implementation of cost-effective approaches to mitigate the consequences of AIDS.