The Changing HIV AIDS Landscape: Selected Papers for the World Bank's Agenda for Action in Africa, 2007-2011

Contents......Page 7
Contributors......Page 17
Acknowledgments......Page 18
Abbreviations......Page 19
Introduction......Page 23
I Epidemiology and Technology......Page 29
Improved Surveillance......Page 31
From Epidemiology to Interventions: What Is Working?......Page 40
1.11 Behavior Change in Manicaland, Zimbabwe, 1998–2003......Page 45
References......Page 49
2 The Evolution of HIV/AIDS Programs: Recent and Ongoing Developments in Selected Areas......Page 51
Prevention......Page 52
Treatment......Page 67
Monitoring and Evaluation......Page 71
Summary of Implications......Page 74
References......Page 76
II Economic Aspects and Economic Policy Issues......Page 83
3 Links between HIV/AIDS and Development......Page 85
How May HIV/AIDS Affect Development? Main Theoretical Channels......Page 88
Empirical Evidence......Page 91
Concluding Remarks......Page 98
References......Page 99
4 Demographic and Socioeconomic Patterns of HIV/AIDS Prevalence in Africa......Page 103
Methodological Issues......Page 104
4.1 HIV Prevalence and Share of Population with Secondary Education, by Age Group, 1989–90......Page 110
Conclusion......Page 120
Notes......Page 122
References......Page 123
5 HIV/AIDS and Social Capital in a Cross-Section of Countries......Page 127
Links between Social Capital and Development......Page 128
Social Capital and HIV/AIDS......Page 129
The Empirical Model......Page 131
Conclusion......Page 139
References......Page 143
6 Fiscal Space and the Sustainability of HIV/AIDS Programs in Sub-Saharan Africa......Page 145
Financing HIV/AIDS Expenditures and the Challenges of Scaling Up Aid......Page 146
Fiscal Space, Sustainability, and HIV/AIDS Programs......Page 150
Country Case Studies......Page 154
6.9 Current Commitments of International Resources to Malawi for HIV/AIDS......Page 177
Notes......Page 178
References......Page 179
III Policy Challenges......Page 181
Summary......Page 183
The Response to HIV and the Mobilization of Resources......Page 186
7.1 Most Important Public Health Priorities Identified by Respondents in Low- and Middle-Income Countries, by World Region......Page 198
The Way Forward......Page 212
Notes......Page 214
References......Page 215
8 Impact of and Response to HIV/AIDS: Public Policy Challenges......Page 219
Overview of the Global AIDS Epidemic......Page 220
8.2 Impact of HIV/AIDS on Number of Orphans in Sub-Saharan Africa, 2001 and 2007......Page 224
Scaling Up the Response to HIV/AIDS......Page 232
Conclusions......Page 242
Notes......Page 244
References......Page 245
9 Gender and HIV/AIDS......Page 249
Gender-Based Vulnerability to HIV/AIDS......Page 250
Institutional Responses, Strategies, and Actions......Page 261
9.2 Selected Countries for the 2006 Portfolio Review of Gender Mainstreaming within the Multi-Country HIV/AIDS Program (MAP) for Africa......Page 262
Conceptual and Institutional Challenges for Gender Mainstreaming......Page 267
Looking Ahead: A Poverty-Focused Strategic Approach......Page 270
References......Page 282
10 The Private Sector and HIV/AIDS in Africa: Recent Developments and Implications for Policy......Page 289
Impact on and Response to HIV by Employers......Page 291
Lessons for Policy......Page 306
References......Page 313
11 Community Initiatives and HIV/AIDS......Page 317
What Are Community Initiatives?......Page 319
11.1 HIV/AIDS Services Provided by 96 FBOs in South Africa......Page 321
11.1 The Gambia MAP Experience......Page 323
11.2 Saving Lives in Ethiopia: The Critical Role of FBOs......Page 326
Recommendations for External Funding Agencies......Page 337
References......Page 339
IV Strengthening National Health Systems......Page 343
12 HIV/AIDS and Human Resources for Health......Page 345
Demand for Health Workers in Sub-Saharan Africa......Page 346
Supply and Performance of Health Workers in Sub-Saharan Africa......Page 349
Impact of HIV/AIDS on the Health Worker Shortage in Africa......Page 353
Reducing the Demand for and Increasing the Supply of Health Workers......Page 369
Need for Supportive and Enabling Fiscal and Political Environments......Page 378
Conclusion......Page 381
Notes......Page 382
References......Page 383
13 Linkages between HIV/AIDS, Sexual and Reproductive Health, Tuberculosis, and Nutrition......Page 391
Linking Sexual Reproductive Health and HIV/AIDS Programs......Page 393
13.2 Actual, Projected, and MDG Target Prevalence of Tuberculosis......Page 404
Linking Nutrition and HIV/AIDS Programs......Page 417
Conclusion......Page 425
References......Page 426
14 Strengthening Health Systems: The Role of Supply Chains in Addressing the HIV Epidemic......Page 433
14.2 Commodities, Services, and Systems for a Comprehensive HIV/AIDS Program......Page 435
Problems with Healthcare Supply Chain Systems......Page 437
Review of the Approaches of Addressing Supply Chains......Page 440
Framework for Planning a Comprehensive Improvement in Supply Chains......Page 444
Conclusion......Page 446
References......Page 447
V Future......Page 449
15 The Potential Impact of HIV/AIDS Interventions on the HIV/AIDS Epidemic in Africa: A Simulation for the World Bank......Page 451
Current Status of the HIV/AIDS Epidemic......Page 452
15.2 Number of Sub-Saharan Africans Needing Antiretroviral Treatment and Number of People Receiving It, by Region, 2007......Page 453
Conclusions and Recommendations......Page 470
Notes......Page 471
References......Page 472
Index......Page 475
7.1 OECD HIV/AIDS Database......Page 190
7.2 The Global Fund to Fight AIDS, Tuberculosis, and Malaria......Page 201
7.3 UNITAID......Page 203
9.1 Empowering Women in The Gambia......Page 263
9.2 Targeting High-Risk Groups in Zambia with Gender-Relevant Interventions......Page 264
9.3 Adopting a Community-Based Participatory Approach in Cameroon......Page 265
9.4 Gender-Sensitive Indicators for HIV/AIDS Programs......Page 266
11.3 The Case of Uganda: Challenges in Attributing Success......Page 332
11.4 Benefits of Community Sector Involvement for National Response to HIV/AIDS......Page 334
12.1 HIV-Related Task Shifting in Sub-Saharan Africa......Page 371
1.1 Most Recent Antenatal and Population-Based Estimates of HIV Prevalence in Selected Countries......Page 32
1.2 Sub-Saharan Africa HIV Adult (15–49) Prevalence Rate, 2007......Page 33
1.3 Global HIV Adult (15–49) Prevalence Rate, 2007......Page 34
1.5 HIV Transmission Dynamics in Nairobi, Kenya......Page 37
1.6 HIV Transmission Dynamics in Zambia......Page 38
1.7 HIV Prevalence among Pregnant Women in Kenya, 1990–2006......Page 41
1.8 Behavior Change in Kenya, 1998–2003......Page 42
1.10 Behavior Change in Uganda, 1989–95......Page 43
1.12 Behavior Change and HIV Prevalence in Cambodia, 1997–2001......Page 46
1.13 HIV Prevalence in India, 2000–2004......Page 47
1.14 Behavior Change and Declining HIV Prevalence in Thailand, 1989–98......Page 48
2.1 Timing of Mother-to-Child Transmission......Page 62
2.2 Antiretroviral Drug Approval by the FDA, 1987–2007......Page 68
3.1 Adult Mortality 1960–2002, by Region......Page 86
3.2 Life Expectancy at Birth, 1960–2004, by Region......Page 87
3.3 Ratio of Selected Development Indicators in Countries with High Prevalence of HIV/AIDS to Average Indicators in Sub-Saharan Africa......Page 92
4.2 GNI per Capita and HIV Prevalence among 34 Sub-Saharan African Countries......Page 111
6.1 External Resources as a Percentage of Total Health Expenditures in Selected Countries in Sub-Saharan Africa, 2003......Page 147
6.2 Expenditures by Private Prepaid Plans as a Percentage of Private Expenditures on Health in Selected Countries in Sub-Saharan Africa, 2003......Page 149
6.3 Control of Corruption Indicators in Selected Sub-Saharan African Countries, 2006......Page 151
6.4 Government Expenditures on Health as a Percentage of Total Government Expenditures in Botswana, 1998–2004......Page 156
6.5 Government Wage Bill as Share of Recurrent Budget in Botswana, 1994–2007......Page 157
6.7 Botswana: Central Government Debt-to-GDP Ratio, 1982 to 2008......Page 158
6.8 Debt Service as a Percentage of Exports in Botswana, 1982–2003......Page 159
6.9 Net Official Development Assistance as a Percentage of GDP in Ethiopia, 1981–2003......Page 162
6.10 Government Expenditures on Health as Percent of Total Government Expenditures in Ethiopia, 1998–2004......Page 163
6.12 Tax Revenue as a Percentage of GDP in Ethiopia, 1981–2005......Page 164
6.13 Central Government Debt-to-GDP Ratio in Ethiopia, 1983–2005......Page 165
6.14 Debt Service as a Percentage of Exports in Ethiopia, 1982–2004......Page 166
6.15 Net Official Development Assistance as a Share of GDP in Malawi, 1980–2003......Page 170
6.16 Government Expenditures on Health as Percentage of Total Government Expenditures in Malawi, 1998–2004......Page 171
6.18 Malawi: Tax Revenue as Percent of GDP, 1980–2009......Page 172
6.19 Actual and Projected Central Government Debt-to-GDP Ratio in Malawi, 1993–2009......Page 173
6.20 Debt Service as a Percentage of Exports in Malawi, 1980–2002......Page 174
7.1 Net Disbursements of Official Development Assistance to Developing Countries, 1970–2006......Page 187
7.2 Total Annual Resources Available for HIV/AIDS, 1998–2007......Page 188
7.3 Bilateral and Multilateral Assistance for HIV/AIDS by DAC Countries, 2003–07......Page 191
7.4 Percentage of Health and Population Donor Commitments, 1998–2006......Page 193
7.5 Commitments for Health and Population by Subsectors in 2006 Dollars, 1998–2006......Page 194
7.6 Most Important Development Issues in 12 African Countries, 2000–2005......Page 197
7.7 Country Progress in Improving the Quality of the Three Ones......Page 208
8.1 HIV Prevalence and Number of People Living with HIV/AIDS, 2001–07......Page 222
8.2 Ten Countries Account for Most of Increase in Number of People Living with HIV/AIDS between 2001 and 2007......Page 223
8.3 Percentage of Orphans by Age Consistent with Average Orphan Rate of 15 Percent among the Population under Age 17......Page 225
8.4 Deaths among Civil Servants in Malawi, by Age and Gender, 1990–2000......Page 228
8.5 Projected Number of Pension Recipients by Pension Type, 2005......Page 231
8.6 Availability of Health Personnel and Access to Treatment in Selected Countries in Sub-Saharan Africa, 2003......Page 237
8.7 Correlation between High HIV Prevalence Rates and Access to ART......Page 239
9.1 Estimated Ratio of Female to Male HIV/AIDS Prevalence Rates among 15- to 24-Year-olds in Sub-Saharan Africa, by Country......Page 251
11.2 Cost Comparisons between Different Community Initiatives in South Africa......Page 328
11.3 Time Allocation across Initiatives......Page 329
12.1 Health Workers per 1,000 People, by World Region, 2004......Page 350
12.2 Countries in Sub-Saharan Africa in Which Prevalence of HIV Is High and Shortage of Health Workers Acute......Page 351
12.3 Percentage of Health Workers Absent from Health Facilities in Zambia......Page 352
12.5 Importance of Various Job Characteristics to Health Care Workers in Ethiopia......Page 357
12.6 Medical Brain Drain Flows, by Region and Year, 1991–2004......Page 358
12.8 Level of Job Satisfaction of Health Workers in Zambia......Page 363
12.9 Attitudes of Health Care Workers in Ghana and South Africa toward Treating People with HIV/AIDS......Page 364
12.10 Monthly Income of Physicians and Nurses in Ethiopia, by Region......Page 376
12.11 Government Expenditure on Health as Percentage of Total Budget in Selected Countries in Saharan Africa......Page 379
12.12 Annual per Capita Health Expenditures in Zambia......Page 380
13.1 Components of Sexual Reproductive Health and HIV/AIDS Programs......Page 396
13.3 Estimated Prevalence of HIV among Adults Ages 15–49 in Sub-Saharan Africa and Globally, 1990–2007......Page 405
14.1 Standard Care Services for HIV/AIDS \"Continuum of Care\" Model......Page 434
14.3 The Supply Chain: Facilities and Resources......Page 438
14.4 The Logistics Cycle: Functions and Activities......Page 439
14.5 Three Supply Chain Types......Page 445
15.3 Projected Number of People on Antiretroviral Therapy Given Universal Access, 2004–11......Page 456
15.5 Impact of Universal Access to Treatment: Number of AIDS Deaths Averted in Sub-Saharan Africa, 2007 through 2015......Page 457
15.6 AIDS Deaths Averted as a Percent of Total AIDS Deaths, 2009 through 2015......Page 458
15.8 Total Resources Required for Care and Treatment in Sub-Saharan Africa, 2009 through 2015......Page 459
15.9 Cost-Effectiveness of Achieving Universal Access to Care and Treatment by 2010 and Cumulative Cost per Deaths Averted or Life-Years Gained, 2009 through 2015......Page 460
15.12 Infections Averted as a Percent of Total New Infections, 2009–15......Page 461
15.13 Infections Averted due to Prevention Interventions in Sub-Saharan Africa, 2007–11......Page 462
15.14 Effect of Prevention Interventions on Adult HIV Incidence in Africa (by Region) through 2015......Page 463
15.16 Incremental Cost per Infection Averted in Sub-Saharan Africa, 2009–15......Page 464
15.17 Number of Infections Averted and Cost-Effectiveness Ratio by Prevention Intervention......Page 465
15.18 Number of Orphans and Vulnerable Children due to HIV/AIDS in Sub-Saharan Africa through 2011......Page 468
15.20 Total Resources Required for Orphans and Vulnerable Children in Sub-Saharan Africa, 2007 to 2011......Page 469
1.1 Distinctions between Concentrated and Generalized HIV Epidemic......Page 35
1.2 Epidemic Typologies: Implications for Action......Page 39
4.1 HIV Prevalence in Ethiopia and Kenya, by Schooling and Residence......Page 107
4.2 HIV Prevalence among Adults 18 and Older in Uganda, 1989–90......Page 109
4.3 Early Marriage as a Determinant of HIV-Positive Status among Women Who Have Been Married, by Age Group, Selected Countries......Page 115
4.4 Discordance in HIV Status among Cohabiting Couples......Page 117
4.5 Discordance in HIV Status among Couples in Which the Woman Was Never Married Before and Has Been in the Union for 10 Years or More......Page 119
4A.1 Prevalence and Number of People Infected with HIV in Sub-Saharan Africa, by Country, 2005–07......Page 121
5.1 HIV/AIDS and Social Capital OLS Estimates......Page 134
5.2 Sensitivity Analysis......Page 137
5A.1 Overview of Data and Sources......Page 140
5A.2 Countries Included in Regressions......Page 141
5A.3 Correlation Matrix and Descriptive Statistics......Page 142
6.2 Resource Needs in Botswana under the Low Scenario, 2007–13......Page 160
6.3 Commitments of International Resources for Fighting HIV/AIDS in Botswana, as of December 2006......Page 161
6.4 Resource Needs in Ethiopia under the Baseline Scenario, 2007–13......Page 167
6.6 Commitments of International Resources for Fighting HIV/AIDS in Ethiopia, as of December 2006......Page 168
6.8 Resource Needs in Malawi under the Low Scenario, 2007–13......Page 176
8.1 HIV/AIDS Prevalence, Incidence, and Deaths, by World Region, 2001 and 2007......Page 221
8.3 Estimated Survival Probabilities for 20-Year-Old Men and Women, Given HIV Prevalence of about 20 Percent......Page 229
8.4 Financing of Health Expenditures in Selected Countries in Sub-Saharan Africa......Page 233
8.5 Domestically and Externally Financed HIV/AIDS–Related Expenditures in Selected Sub-Saharan African Countries, 2005......Page 234
8.6 Migration of Physicians and Nurses from Selected Countries in Sub-Saharan Africa, around 2000......Page 236
8A.1 Availability of Medical Professionals and Access to Treatment in Selected Countries in Sub-Saharan Africa......Page 243
9.1 Determinants of Vulnerability to HIV/AIDS by Males and Females......Page 253
9A.1 Checklist for Mainstreaming Gender Issues into HIV/AIDS Strategies and Action Plans......Page 272
9A.2 Checklist for Mainstreaming Gender Issues into HIV/AIDS Programs and Projects......Page 279
10.1 Estimated Impact of HIV/AIDS on Labor Costs at 14 Companies in Sub-Saharan Africa......Page 293
10.2 Private Sector ART Treatment in Selected African Countries......Page 300
10.3 Models of Treatment Interventions in Africa......Page 301
11.1 Services Provided across Initiatives......Page 330
12.1 Estimated Health Resources Needed to Provide ART in Mozambique......Page 347
12.2 Estimated Annual Production of Physicians and Other Medical Professionals in Selected Sub-Saharan Countries, 2003......Page 354
12.3 Push and Pull Migration Factors in Sub-Saharan Africa......Page 360
12.4 Estimated Rate of Premature Mortality in Selected African Countries......Page 361
12.5 Number of Staff Who Joined and Left Health Facilities in Zambia in 2006......Page 362
12.6 Income-Augmenting Activities of Health Staff in Zambia, 2006......Page 365
12.7 Level of Knowledge of Medical and Nursing Students in Rwanda......Page 367
12.8 Permanent Trainers with PhDs at the Faculty of Medicine, National University of Rwanda, 2006......Page 373
12.9 Management Functions Related to Human Resources for Health......Page 374
12.10 Facility-Level Infrastructure, Logistics, and Supplies in Ethiopia......Page 377
13.1 Typology of Countries by HIV and Contraceptive Prevalence Rate......Page 397
13.2 Classification of Countries in Sub-Saharan Africa by Level of HIV and Tuberculosis Prevalence......Page 408
13.3 Potential Tuberculosis and HIV Interventions Based on Level of Care......Page 410
15.1 Coverage of Key HIV/AIDS Interventions in Sub-Saharan Africa, 2005......Page 454
15.2 Projected HIV/AIDS Intervention Coverage Reached in 2010, by Type of Epidemic......Page 455
15.3B Cross-Classification of Interventions by Cost-Effectiveness and Impact for Central/Western Africa......Page 466