 | The fight against HIV/AIDS in South Asia will not be won only by those already proudly dedicated to wearing the emblematic red ribbon. It will be won when those who don’t really think AIDS affects them directly wake up and make it their business too; make it everyone’s business. This is the message that the World Bank team is taking to the 7th Annual International Conference on AIDS in Asia-Pacific in Kobe Japan. |
 | | The World Bank Fights HIV/AIDS |
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| What's happening in my country now? |
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KOBE, Japan - July 1 2005 The first case of HIV/AIDS in South Asia was reported in India in 1986. Today, just 19 years later, more than five million HIV-positive people live in South Asia. HIV/AIDS has gained a foothold in the region. The challenge today, both for the countries and the donors which support them, is to do everything possible to prevent the further spread into a full-scale epidemic the likes of which we have seen in other parts of the world with devastating social and economic impact. All of the governments in South Asia have intensified their fight against HIV/AIDS, but the virus is continuing to spread faster than their efforts.
The cultural diversity of South Asia is rich but there are risk factors for HIV/AIDS that are common to all countries. Health systems are over-burdened, many poor have to travel far from home to work, while others are forced to sell sex for their own survival. Illiteracy and isolation exclude millions from access to adequate information and services. Drug use by injection is increasing, and women do not have the power to negotiate safe sex.
Avoiding a full-blown epidemic is possible, but it will take effort across entire societies to make HIV/AIDS everyone’s business. The region’s political leaders have to show the way with commitment and leadership. But this will not be enough. It will also take the sustained dedication of civil society leaders. And not just nongovernmental organizations (NGOs) but those in the private sector, the media, religious bodies, academia, and the arts. It will also take donors like the World Bank and others to work in stronger unison to support comprehensive multisectoral programs. In addition to the obvious health sector involvement, HIV/AIDS has to be top-of-mind across the board as the business of the transport ministry, education (public and private), urban and rural development and law enforcement.
HIV/AIDS is still commonly seen as a problem to be dealt with by the health departments, doctors and health workers alone. The only way to move effectively and faster than the HIV/AIDS epidemic is to attack it from all angles. This means including it in the school health curricula and encouraging heads of universities to get involved to break the silence and stigma. This means that transportation projects include HIV/AIDS training and prevention measures to project employees—as well as truckers and migrant workers. This means that the police are sensitized to help prevent discrimination and harassment of highly vulnerable populations, such as sex workers, the peers who deliver HIV/AIDS services or who are themselves HIV positive. This means that when we help women mobilize to learn to read or start a savings and loan—that we also teach them about HIV/AIDS.
Businesses of course have a key communications and advocacy role early in the epidemic. They will feel the impact of the AIDS epidemic as it evolves through their workforce, with direct consequences for a company's bottom line.
The cost of doing nothing includes increased medical expenditures and health insurance costs, funeral and death benefits, as well as higher recruitment and training needs due to lost personnel. Other financial impacts include the effects of higher absenteeism and staff turnover, reduced productivity, declining morale and a shrinking consumer base. And while revenues shrink, costs of doing business rise due to disruptions in supply chains similarly affected by an epidemic. For all these reasons, the early involvement of the private sector is critical to curbing the epidemic.
There have been some good examples already in South Asia of responsiveness by government, civil society, and the private sector. For example, Indian Railways is currently providing services to its workers, including voluntary counselling and testing centres, and care and treatment for HIV-positive employees, complementing the government contributions of the National AIDS Control Organization. In Sri Lanka, the armed forces have set up voluntary counselling and testing centres and condom promotion in military camps, and have integrated HIV/AIDS education into the curriculum for new recruits. In Bhutan, the police force has introduced HIV/AIDS and sexually-transmitted infections (STI) education to officers and their families to promote safer behaviours and reduce stigma.
Private companies in India have also begun to move. Apollo Tyres, Ambuja Cement, L&T, Usha Martin and Ashok Leyland have workplace knowledge programs about HIV/AIDS, reaching throughout their groups and, importantly, to their supply chain partners. They are establishing clinical facilities, and supporting or scaling-up awareness and prevention efforts to the communities with whom they interact on a daily basis. These are precisely the right sort of forward-thinking examples that will make all the difference but they are still hard to find. Political leadership at the highest level needs to call upon key sectors of society to act; resources need to be channeled into key (health and non-health) sectors to support their programs; and capacity needs to be developed to design and implement effective programs.
We cannot afford to miss any opportunity that will help people understand this devastating affliction, protect themselves and give their support and understanding to those already infected.
Across South Asia, the World Bank is assisting national programs which are working to prevent the further spread of HIV/AIDS. Between the three important principles of concerted action underpinning our work, none is more important than the other so they are called the “Three Ones”:
One agreed HIV/AIDS Framework that provides the basis for coordinating the work of all partners; One National AIDS Coordinating Authority, with a broad based multisectoral mandate; and One agreed country level Monitoring and Evaluation system.
With a commitment to date of about US$380 million in South Asia, the Bank supports projects in Bangladesh, Bhutan, India, Pakistan and Sri Lanka, and assessment work in Afghanistan and Maldives. The World Bank’s expertise lies in helping to strengthen the public institutions—the Ministries of Health, Education, Uniformed Services, and Transportation, to deliver effective HIV prevention and care services to the people of these countries. But we also work with NGOs, which can deliver HIV/AIDS support to the poorest, most remote and hardest to reach communities. We support private sector involvement, and we support community mobilization and community-based interventions that enable open discussions about HIV/AIDS, reduce stigma, and help prevent discrimination.
The International Finance Corporation, the private sector investment arm of the World Bank Group, recognizes that HIV/AIDS is as much a business issue as it is a development and humanitarian concern. Since 2000, the IFC AIDS program—IFC Against AIDS—has worked to increase the private sector’s role in fighting the epidemic.
By making HIV/AIDS the business of everyone, South Asia has a fighting chance of staying ahead of an epidemic. |
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