The impact of HIV/AIDS is especially pronounced in the Caribbean which has the highest prevalence rate in adults outside of Sub-Saharan Africa. A total of 250,000 people are living with HIV/AIDS in the Caribbean including 27,000 people who were newly infected in 2006.

HIV/AIDS is one of the leading causes of death among adults aged 15-44 years in the Caribbean. In 2005, the Caribbean was the only region in the World where the overall number of people living with HIV has not continued to increase. Diagnosis of new HIV cases among pregnant women decreased in Barbados, Bahamas and Bermuda. In Haiti, the country with the highest adult prevalence (3.8%) in the Caribbean, HIV declined in urban areas from 9.4% in 1993 to 3.7% in 2003/4, while the rate among pregnant women declined by a half during the same period. With the exception of Cuba, Bahamas and Barbados where access to antiretroviral therapy is high, antiretroviral treatment is uneven with fewer than 20% of people who need the treatment accessing it.

What is fueling the epidemic in LAC countries? The HIV virus is transmitted predominantly through unsafe sex (both heterosexual sex and sex between men) and injecting drug use. Factors which contribute to the spread of HIV/AIDS include:

• Social factors include poverty and unequal gender relationships in which women are economically dependent on men and have fewer opportunities to negotiate safe sex. There is also early sexual activity among youth.

• Political and economic instability lead to migration and mobility of people resulting in separation of families and new relationships which facilitate transmission of the virus. Such crises result in impoverishment of people who are driven to adopt coping mechanisms which expose them to infection. They also result in reduced resources available HIV/AIDS programs.

• Stigma and discrimination are directed at people living with HIV/AIDS, homosexuals, commercial sex workers, injecting drug users and other at-risk groups, fuelling the epidemic by driving it underground.

• Lack of implementation capacity undermines the effectiveness of programs designed to prevent HIV infection or provide treatment to those living with AIDS. High turnover of human resources, exacerbated by political and economic crises as well as the epidemic itself, further weakens the capacity of countries to respond to the epidemic.

THE WORLD BANK'S RESPONSE TO HIV/AIDS IN LATIN AMERICA AND THE CARIBBEAN

The World Bank is working with the region's governments, civil society, donors, and other international organizations to provide critical financial resources and technical assistance to prevent the spread of HIV/AIDS and provide treatment and care for people infected and affected by HIV and AIDS. The Bank’s total HIV/AIDS active portfolio in the Latin America and Caribbean region is approximately US$247.1 million.

The participation of civil society organizations in the fight against the epidemic is a key pillar of all Bank-financed projects because of their proven effectiveness in working with vulnerable and high-risk groups that are often hard to reach through traditional public institutions.

• The Bank has provided a total of $425 million to Brazil in three HIV/AIDS projects, which have contributed to program decentralization and integration into primary health care. Action Plans including targets were developed by 26 States and the Federal District and 419 municipalities, covering 96 percent of AIDS cases. The most recent project is financing about half of all civil society subprojects financed by the NAP (700 out of 1,500) to work with vulnerable groups at the community level. The project will increase condom distribution from 700 million in 2005 to 1 billion in 2006. Work is underway to develop technologies that allow for more efficient and decentralized action against the epidemic. Subprojects for the development of a vaccine, microbicides and diagnostic kits are also in implementation.

• In response to the severe economic crisis of 2002 in Argentina, 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.

• World Bank-funded health sector projects in Mexico ($300 million), Venezuela ($30.3 million), Honduras ($31.41 million), El Salvador ($142.6 million). and Guatemala (US$49 million) support HIV/AIDS. A health project for Argentina which will include support for HIV/AIDS interventions is under preparation.

• An $8 million grant is supporting a regional HIV/AIDS program for six countries (El Salvador, Costa Rica, Guatemala, Honduras, Nicaragua and Panama) in Central America. The support includes the development of a regional HIV/AIDS laboratory system, epidemiological surveys, and interventions to prevent HIV infection among mobile populations.

• In 2001, the Bank approved a $155 million Multi-Country HIV/AIDS program to finance HIV/AIDS prevention and control programs in the Caribbean. A total of $117.65 million in assistance has been committed for nine Caribbean countries under the program for: the 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), St. Lucia (2004), and St. Vincent and the Grenadines (2004). This has enabled the countries to strengthen their prevention efforts, provide treatment and care to people living with HIV/AIDS and mitigate its impact, as well as strengthen their institutional capacity to manage the epidemic.

• A $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/ World Health Organization.

Beyond financial assistance, the World Bank has conducted analytical work to improve understanding of HIV/AIDS in the region. Among the reports produced are the following:

• Protecting Children Affected by AIDS in the Caribbean: Recommendations for Legal Reform in St. Vincent and the Grenadines, Guyana, St. Lucia and Grenada. (Forthcoming, 2006).

• Optimizing the Allocation of Resources among HIV prevention interventions in Argentina. (2006)

• Optimizing the Allocation of Resources among HIV prevention interventions in Mexico, Panama and Honduras. (2002)• HIV/AIDS in the Caribbean Region: A multi-organization Review (2005)

• HIV/AIDS in Latin American Countries, The Challenges Ahead (2003)

• HIV/AIDS in Central America: An Overview of the Epidemic and Priorities for Prevention (2003)

• HIV/AIDS in the Caribbean: Issues and Options (2001)

These studies have provided guidance for countries in determining priorities for dealing with the epidemic within their national HIV/AIDS programs.The Bank also supports regional and sub-regional HIV/AIDS-related initiatives and conferences. Bank staff participated in the Champions for Change High Level Conference addressing Stigma and Discrimination in St. Kitts (November 2004); the fifth annual meeting of the Pan-Caribbean Partnership Against HIV/AIDS and the Latin America Regional Conference on HIV/AIDS (CONCASIDA), both held in October 2005; the Caribbean Consultation on universal Access to HIV/AIDS Prevention, Treatment, Care and support services in Jamaica, 2006; the UN System Consultation on Addressing HIV/AIDS and Sex Work, Geneva, 2006; and, the Global Consultation on HIV and Sex Work in Brazil, 2006. The Bank also participates in other regional coordination meetings of partners.

Successes are being registered in fighting the epidemic in Latin America and the Caribbean:

• In Brazil, the number of new HIV/AIDS cases reported annually has leveled off. It had been predicted that Brazil would have 1.2 million people living with HIV/AIDS by 2000, today the number is estimated at 600,000. Mortality due to AIDS and hospitalizations has decreased significantly.

• In Barbados, new HIV diagnosis among pregnant women decreased by half between 1999 and 2003. Access to ARV cut AIDS deaths by half over the same period. Similar trends have been seen in the Bahamas and Bermuda.

• The epidemic in Haiti (the highest in the Caribbean) is showing signs of slowing down with the trend most pronounced in urban areas, where HIV fell from 9.4% in 1993 to 3.7% in 2003/4.

• Cuba’s epidemic remains the lowest in the Caribbean. Overall, the Caribbean is the only region in the world where the overall number of people living with HIV has not continued to increase.

Despite these gains, access to prevention and treatment is still low in many countries of Latin America and the Caribbean. Countries need a sustained and intensive effort through an integrated approach that ensures that both effective prevention to reduce the number of new infections and universal treatment and care for people living with HIV/AIDS.

Updated April 2007

Media Contact:

Stevan Jackson

sjackson@worldbank.org

Telephone: %201 (202) 458-5054