March 2002

THE IDB AND HIV/AIDS

IDB SUPPORTS DIALOGUE AND AWARENESS TO PREVENT HIV/AIDS SPREAD IN LATIN AMERICA AND THE CARIBBEAN

New program to foster discussion on effective interventions

The Inter-American Development Bank is a committed partner in the international effort to halt the spread of HIV/AIDS, identified at the Summit of the Americas in Quebec in April 2001 as a threat to the security of Latin America and the Caribbean, where about 1.8 million persons live with the disease.

IDB operations address HIV/AIDS not only from the health sector, but also as a broader social and development issue under the umbrella of its inclusion and social equity activities. The stigma attached to HIV/AIDS has led to widespread discrimination. In addition, the disease has a high incidence in excluded populations, such as those with high levels of poverty, low education and limited access to health and information services, that restrict their ability to cope with its impact.

In Latin America and the Caribbean there are areas where more policy-level support is needed if the spread of the epidemic and its social consequences are to be avoided. For example through the implementation and enforcement of anti discrimination policies in employment and housing, expanded access to treatment and care, and the development of sustained and well targeted prevention programs. Increased focus is also being given to access to medications, their cost, and the support services needed to successfully administer them.

The Bank’s HIV/AIDS initiative presented in Quebec focused on four areas: prevention, access to medications, support to the networks of persons living with AIDS, and increasing private-public sector partnerships.

The IDB, the Pan American Health Organization, and the World Bank signed in 2000 an agreement and are developing a Shared Agenda for Health in the Americas to coordinate efforts to improve health conditions and public health services in the region through joint actions, including disease prevention and control.

Initiatives in the region

The first HIV/AIDS Bank activity was implemented in 1995 Honduras, as support for the National AIDS Prevention and Control Program. HIV/AIDS issues were covered in subsequent technical cooperations in the Bahamas for adolescent reproductive health education, and Jamaica. A range of cooperations focused on HIV/AIDS are under execution in Haiti and Honduras and efforts are underway to adjust existing operations in Guatemala and Nicaragua to include HIV/AIDS activities.

The Plan Puebla-Panama has at the core of its Human Development Initiative, an HIV/AIDS and Epidemiological Surveillance Program that is supported by all the governments of the region. While still in the design stage, the Bank has programmed non-reimbursable resources to prepare a project aimed at supporting high-risk populations in the Meso-American corridor.

The IDB has supported the development of the health infrastructure in Latin America and the Caribbean with almost $2 billion in financing during the past decades. This resources, in addition to grants and technical cooperation, were key for the treatment and care aspects of HIV/AIDS programs. Together with PAHO/World Health Organization and bilateral donors, the Bank has also supported the strengthening of epidemiological surveillance systems that have improved knowledge on how the epidemic has spread.

Nicaragua and Guatemala asked the Bank for specific assistance in adjusting loans for health operations to include HIV/AIDS activities starting in 2002. The Bank has also included HIV/AIDS components in its portfolio of new social and health programs and is designing a technical cooperation program to foster research in the areas of awareness and behavior change.The IDB will continue to integrate issues regarding HIV/AIDS in its portfolio, especially in the areas of education and assistance for women, youth and excluded groups.

The IDB answered the mandate from the 2001 Summit of the Americas by preparing a program aimed to support activities in 3 areas: public policy dialogue, strengthening of non-government organizations that provide services to persons living with HIV/AIDS, and involvement of the private sector.

Public policy dialogues

A series of dialogues will be initiated that focus attention on the economic and social aspects of the disease. The dialogues will focus on four main areas: (1) Improved Access to Comprehensive Prevention, Treatment and Care; (2) Economic Impact, Resource Needs and Allocation Patterns; (3) The Effect of Discrimination, Stigma and Gender in HIV/AIDS Programs and (4) The Impact of HIV/AIDS on Public Policy.

Advocacy work with policy makers will be supported by research studies that focus on the economic and social aspects of the epidemic. The focus will be on examining, implementation needs and best practices, resource allocation patterns and prioritization in resource poor environments. These studies will provide national HIV/AIDS programs and lenders an estimate of the level of resources needed to mount comprehensive programs.

In the area of behavior change, a pilot operation will test newly developed behavioral surveillance methodologies to monitoring changes in HIV/AIDS-related behaviors and evaluating the impact of behavior change programs. The project will support the collection of data on indigenous populations in Bolivia and among youth in Uruguay.

This program is expected to generate greater information and understanding of the factors leading to the successful design, operation, and evaluation of policies and projects designed to fight the spread of HIV/AIDS.

Strengthening NGOs

Enhancing an expanded response requires still more attention to building NGOs capacity, particularly that of NGOs of people living with AIDS, which are in a unique position to reach out to persons and families affected. In many countries, one of the first responses to the epidemic came from the NGO sector. However, there is need for greater coordination among NGOs to ensure that limited resources are used more efficiently.

Working with UNAIDS, the Bank will support the institutional strengthening of umbrella HIV/AIDS NGO groups (Foros Nacionales) in Paraguay, Uruguay, Chile and Argentina. The objective of these groups will be to help consolidate the response from the NGO community.

The forums will be involved mainly in the analysis of relevant policy and the provision of information and improving access to health and social services for persons living with HIV/AIDS. With UNAIDS, the Bank will support the strengthening of linkages between the four national bodies and the evaluation of the impact of this model for coordinating the NGO response.

In Chile, the Bank will support Vivo Positivo, a large NGO working with persons living with AIDS, in the development of a pilot project on AIDS, Ethics and Human Rights, that will include a new element: HIV/AIDS prevention for persons with HIV, with focus on issues such as re-infection.

Private Sector

The program will seek to encourage the private sector to develop prevention programs and appropriate HIV/AIDS work-place policies. The project will support the development of pilot projects in Barbados and the Bahamas. In the Bahamas, this initiative will seek to build on existing Bank support for HIV/AIDS Business Councils and to foster technical exchanges between the two countries.