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By James D. Wolfensohn

James D. Wolfensohn is president of the World Bank. Here he comments on the worldwide HIV/AIDS epidemic, as the U.N. Special Session on HIV/AIDS opens in New York June 24-27.

WASHINGTON -- Last year alone, AIDS killed almost 3 million people around the world. More than 5 million became newly infected with HIV, nearly 4 million of them in Africa. The HIV/AIDS epidemic is spreading at alarming rates in other regions as well. In Eastern Europe, and South and Southeast Asia, there is evidence that the disease is taking deadly hold of people and their communities. In the Caribbean, AIDS has become the major cause of death among men under the age of 45.

As heads of state, policymakers, U.N. agencies, health experts, civil-society groups and others converge on New York for the U.N. Special Session on HIV/AIDS, these facts should command the world's attention. Under the leadership of U.N. Secretary General Kofi Annan, this high-level global meeting will underscore that HIV/AIDS is no longer just a health problem, but a global development problem, threatening to reverse many of the gains made over the last half-century. More than that, it is an international security problem, and, as such, it needs a war chest and a rigorous strategy.

A growing consensus has emerged among U.N. agencies, donors and stakeholders that a global trust fund offering grants for the prevention and treatment of HIV/AIDS and other communicable diseases is the only way to surmount the very large financing gap threatening to defeat the fight against AIDS. But as such, we want to ensure that the proposed fund provided financing over and above existing foreign aid. To reallocate those funds would simply be a shell game.

I hope and trust that governments, charitable foundations, the private sector, civil-society and other groups attending this special session will respond generously to the challenge of checking the spread of HIV/AIDS and contribute significantly to the war chest that will be needed.

While money alone will not solve the problem, it is a vital part of the solution, and funds earmarked for confronting the epidemic are currently much too low. Total global support for HIV/AIDS in developing countries last year was probably under $1 billion, less than a third of the estimated need in Africa alone.

Dramatic reductions in prices of anti-retroviral drugs are key to treatment. But even they do not provide the magic bullet. At $400-$500 a year, down from $10,000, they are more affordable, but still well out of reach for the vast majority of infected people in developing countries where per capita income is less than $500 per year, and where governments spend less than $5 per person on health care.

Prevention is key. But prevention is costly as well. What is needed is at least $9 billion per year.

The World Bank, in partnership with African governments, has launched the Multi-Country HIV/AIDS Program (MAP) for Africa, which over the past year has provided $500 million in new money to help 10 African countries scale up effective prevention, care and treatment. The MAP makes significant resources available to civil-society organizations and communities, which have developed some of the world's most innovative HIV/AIDS interventions. Next year, we plan to finance another $500 million to reach 15 more African countries.

Moreover, the bank has unveiled a new $150 million fund to fight HIV/AIDS in the Caribbean, and $40 million in recent lending has also gone to support HIV/AIDS prevention and care in Bangladesh.
These reflect a solemn pledge I made last year that there will be no limit to the amount of funding we are willing to provide, and that no national HIV/AIDS program will be stopped because of lack of funding. I reaffirm that commitment. But not one on its own -- not the bank, donor agencies, national governments, NGOs (non-governmental organizations) or the private sector -- will be able to provide the scale of money and support needed to engage HIV/AIDS at the global and country level and ultimately prevail. For this reason, the bank strongly supports the establishment of the global fund within the context of meeting the International Development Goals. These call for a halving of the proportion of people living in extreme poverty by 2015 and also urge greater strides in reducing infant, child and maternal mortality.

Treatment, prevention, implementation -- all these are needed. But there is one more essential element in our strategy. Leadership. In too many countries, AIDS, sex, rape and condoms are subjects rarely mentioned. In too many communities, men believe that sex with a virgin will cure them. The human tragedy surrounding that belief is staggering -- in South Africa today, 95,000 children under the age of 15 are HIV positive, most of them girls. More and more leaders are beginning to break the silence. We need others to follow suit. Rich countries must set an example by putting up funds and offering help to those who speak out.

Collectively we have the resources, and we surely have the need. All we lack is the political will. Let us join with the G-7 and the U.N. system to commit to a global fund. Let us also invite civil society into this global campaign against HIV/AIDS. Its contribution could be enormous. Civil society has played a pivotal role in all countries that have had success against HIV/AIDS. At the global level, representatives of civil society should be involved at all stages in the design, decision making and implementation of HIV/AIDS-related activities. At the country level, civil society should have a direct role in AIDS governing bodies, and those bodies should channel a significant share of HIV/AIDS resources directly to the local level and to community organizations.

So, let us all join arms and show that we are not powerless against this epidemic. Let us mobilize the money, the political will and the battle plans to turn the tide of this global threat. Let us then make this U.N. Special Session on HIV/AIDS a pivotal moment in the fight.

(c) 2001, Global Viewpoint.
Distributed by Los Angeles Times Syndicate International, a division of Tribune Media Services. Distributed 6/20/01