By Lesley Wroughton
WASHINGTON, Nov 28 (Reuters) - Overtaken as the largest funder of global HIV/AIDS programs, the World Bank is now focusing on easing the economic damage inflicted by the disease in Africa and finding ways of controlling its spread through better prevention, care and treatment.
Its changing role has been forced by billions now available through the Bush administration's President's Emergency Plan for AIDS Relief, or PEPFAR, the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria and the Gates Foundation.
Global funding for AIDS reached $9 billion in 2007 compared to $1.6 billion available in 2001.
The World Bank's vice president for Africa, Obiageli Ezekwesili, said a new 5-year action plan for fighting the HIV/AIDS pandemic in Africa sought to ratchet up the bank's role as an adviser to governments and its power to bring together donors to ensure AIDS funding is properly used.
In addition, the World Bank would increase its work among high-risk groups such as prostitutes and commercial sex workers or in other areas where donors were absent, such as countries emerging from conflict.
"The landscape has changed since the bank first took the leadership on HIV/AIDS in 1999 so we have needed to go back to reflect on our future role," Ezekwesili told Reuters.
"Our leverage is still huge and it's that leverage that other partners look to us to play up in the agenda going forward," she added.
According to the latest U.N. figures on AIDS, the global prevalence of HIV/AIDS has leveled off, in part due to effective HIV programs. Still, in 2007 there are 33.2 million people living with HIV, 2.5 million people became newly infected and 2.1 million people died of AIDS.
While the past decade has focused on building a database on HIV/AIDS, better understanding the transmission of HIV and, more recently, on treatment, Ezekwesili said it was time to strike a balance between prevention, care and treatment.
"In a lot of ways the bank brings comparative strengths to all those aspects especially when it comes to groups that are often forgotten," Ezekwesili, a former education minister from Nigeria, said.
PREVALENCE VARIES
According the World Bank, the AIDS virus varies from country to country and region to region, which means programs need to be tailored to specific needs.
The epicenter of the epidemic is in southern Africa, where HIV prevalence ranges from 15 to 35 percent. In east Africa, which was often lumped in with southern Africa, the epidemic is far lower, ranging from 2 to 7 percent. Meanwhile, in west Africa, which includes some of the region's most populous countries, prevalence ranges from 1 to 5 percent.
Ezekwesili said while funding for HIV/AIDS programs had increased to $9 billion, just treating HIV/AIDS in Africa would require doubling that amount.
"Maximizing investments comes through very effective and efficient results-based health systems that can deliver," she said, adding that the World Bank could influence HIV/AIDS strategies through its development programs in countries.
"Any scourge that lowers the life expectancy and productivity of countries will be a major constraint to development and therefore integrating the health issues in development gives you a huge" return, she added. (Reporting by Lesley Wroughton; editing by Cynthia Osterman)
