HIV and AIDS

Frequently Asked Questions

• What is AIDS and how it is contracted?
• What are the main effects of HIV and AIDS?
• What can be done to contain the spread of HIV and AIDS?
• What is ADB doing to prevent the spread of HIV and AIDS?
• Why should ADB be involved in HIV and AIDS related work?
• How is ADB Preventing the Spread of HIV?

AIDS - the Acquired Immuno Deficiency Syndrome - is the late stage of the infection caused by a virus, the Human Immunodeficiency Virus (HIV). HIV steadily weakens the body's defense (immune) system until it can no longer fight off infections such as pneumonia, diarrhea, tumors and other illnesses. Unable to fight back, most people die within three years of the first signs of AIDS appearing.

Most of all HIV infections have been transmitted through unprotected sexual intercourse with someone who is already infected with HIV. HIV can also be transmitted by infected blood or blood products (as in blood transfusions), by the sharing of contaminated needles, and from an infected woman to her baby before birth, during delivery, or through breast-feeding.

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Besides the tragic human suffering caused by HIV and AIDS, the disease causes tremendous economic disruption because it strikes young people in their most productive years. The cost of health care, lost productivity, and care of orphans can weigh heavily on already fragile economies.

AIDS is a disease of poor countries and poor people because the poor have less access to information, education, and health care, and because they are often forced into jobs that make them vulnerable to the disease.

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There are encouraging developments within our region. Early and effective action can stem the spread of the disease. This has been amply demonstrated in Thailand where the spread of the disease has been dramatically reduced. The Indian state of Tamil Nadu has developed effective education campaigns that have slowed the spread of the disease.

Governments, NGOs and civil society must openly address the problem and develop effective, multi-sectoral approaches to prevention. This requires political will and financial resources. Prevention not only averts death and suffering but saves huge amounts for public budgets.

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ADB is supporting actions to prevent and control the spread of HIV at regional and country levels. At the regional level, ADB aims to

• complement individual country actions with coordinated inter-country actions addressing common sources of infection risk that countries share
• facilitate information exchange and sharing of experiences and innovative approaches
• support operations research activities to develop tools and approaches for HIV and AIDS prevention and control

  At the country level, ADB support includes the

• strong advocacy and policy dialogue to obtain greater commitment for HIV and AIDS prevention and care activities
• strengthening of institutional capacities from national and community levels to effectively respond to HIV and AIDS
• mainstreaming of HIV and AIDS in development projects including those in the health, education, rural development and infrastructure sectors
• direct support for HIV and AIDS programs through stand alone projects and technical assistance grants

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ADB's role in responding to HIV and AIDS is guided by its Long-Term Strategic Framework (LTSF) and poverty reduction strategy.

The LTSF identifies sustainable economic growth, inclusive social development and governance for effective policies and institutions as the core strategic areas. The poverty strategy supports the LTSF and suggests the following direction for ADB's overall operations.

"ADB is mainly concerned with interventions having medium- or long-term impact. ADB's strength lies in financing relatively large investments, as well as in conducting policy dialogue with governments in support of policy reform. While physical investments contribute directly to poverty reduction, the policy and institutional environment is also of great importance for sustainable poverty reduction. ADB will therefore adopt a systematic approach to poverty reduction by promoting policy reforms, assisting the development of physical and institutional capacity, and designing projects/programs to better target poverty."

There is a strong rationale for ADB's active role in further strengthening the response to HIV and AIDS in the region on these grounds:

• While Asia and the Pacific have not experienced the extremely rapid spread of HIV and AIDS, as has ravaged sub-Sahara Africa, the underlying conditions for a similarly rapid spread currently prevail in many Asian countries.
• The prevalence of HIV and AIDS is a major development issue that threatens socio-economic development and disproportionately affects the poor and marginalized populations of the region.
• Cost-effective measures are available that can prevent the spread of the disease. If implemented early, these measures are significantly cheaper than actions taken much later in the course of the epidemic.
• The spread of HIV and AIDS has important regional dimensions. National and sub-national level responses need to be complemented by effective regional responses.
• Many infrastructure projects, including those financed by ADB, create conditions that can potentially facilitate the spread of HIV and AIDS and require appropriate mitigating efforts.
• ADB with its regional presence, experience in working with sub-regional groupings, our ability to work on multi-sectoral issues, and our ability to provide substantial investments for the sector and leverage them for policy dialogue is well placed to support a more effective and stronger response to HIV and AIDS.

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• Regional Level
• Country level

Regional Level

Regional Investment Projects. While most of the activities for HIV and AIDS prevention and control are to be organized and implemented at the national, indeed sub-national levels, some need to be planned and implemented at the regional level.

A regional approach is particularly critical for regions with high levels of inter-country mobility. This mobility may include long term or short term migration involving

• sex workers
• construction workers
• truck drivers
• tourists
• businesspersons
• seafarers

In such cases, coordinated prevention efforts are required at the beginning, along, and at the end of migration routes. Since these focal points are spread all over the region, national-level efforts alone would not comprehensively tackle the issue. Moreover, there would not be any direct incentive for one country to work on HIV and AIDS issues involving people from other countries.

In such cases, ADB will support regional investments to complement the national responses. For example, ADB's JFPR project Community Action for Preventing HIV/AIDS focuses on HIV and AIDS prevention activities in source and destination areas of mobile populations in Cambodia, Lao PDR, and Viet Nam.

Information Sharing. Access to adequate information is one of the best AIDS prevention strategies, because it can significantly reduce risky behavior. Knowledge about the epidemiology of HIV and AIDS and about the ways to successfully prevent it is an important regional public good. The creation, evaluation and dissemination of this information would benefit many countries. Yet one country may not sufficiently exert independent, individual effort because that may not be as effective as desired, and because the costs will be borne by one while the benefits may be enjoyed by those outside its borders.

Again, ADB is in the unique position to facilitate the rapid spread of knowledge among countries well ahead of the spread of the AIDS virus. For example, ADB in collaboration with several UN agencies, Sida and AusAID is supporting international and regional conferences, study tours and other information sharing activities including HIV and AIDS related websites.

Developing Effective Approaches. Although much is known about the trends and epidemiology of HIV and AIDS, as well as successful approaches for prevention, care and support, more reliable regional assessments of vulnerability and risk, and impact of HIV and AIDS; and better information on effective approaches for dealing with specific populations and issues are required.

Through its regional technical assistance mechanism, ADB is well positioned to generate these information and to support operations research projects. For example, ADB is supporting the development of tool kits for organizing HIV and AIDS prevention programs around transport sector projects. ADB's regional project Community Action for Preventing HIV/AIDS is developing community based models for AIDS care in Cambodia, which could later be replicated in Viet Nam and Lao PDR.

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Country Level

Advocacy and policy dialogue to raise awareness. Despite the tremendous potential economic and social impacts, many governments are reluctant to address HIV and AIDS. Some may not recognize the existence of the problem. Others may have become complacent, as earlier forecasts of explosive growth of HIV and AIDS have not yet materialized. Still others may be reluctant to address HIV and AIDS directly because of the perceived social and moral issues surrounding individual behaviors and focused prevention programs.

Strong government commitment is essential to make headway against the HIV epidemic. ADB will work with other international agencies including Department for International Development of UK (DFID), Joint United Nations Programme on HIV/AIDS (UNAIDS), United Nations Children's Fund (UNICEF), US Agency for International Development (USAID), World Health Organization (WHO), and the World Bank

• to disseminate information and raise awareness among policy makers about HIV and AIDS in the region
• to convince them to reassess their circumstances and re-examine spending priorities

ADB encourages our Operational Strategy and Country Programming Missions to incorporate discussion of HIV and AIDS-related issues in regular dialogue with policy makers. In particular, Programming Missions can act as a bridge or broker between health ministries and economic planning and finance ministries to discuss HIV and AIDS status, responses and resource allocation issues. These discussions should highlight the high social and economic costs of AIDS and urge allocation of sufficient resources for preventive programs and education.

Capacity Building. Since AIDS is a relatively new concern in the region’s DMCs, institutional capacity to confront this challenge is weak or absent. Country-specific technical assistance can help strengthen the capacity of ministries of health and other ministries and institutions to provide for HIV and AIDS surveillance, prevention and control activities, and care of AIDS patients.

Priority would need to be given to building

• country-level capacity to monitor and understand the course of the epidemic
• capacity to organize and mobilize communities to prevent its further spread
• capacity to control, treat the infected, and contain the epidemic

For countries already facing a serious epidemic, these three types of institutional capacity need to be developed simultaneously; others may still have the relative luxury of building these capacities in sequence. For example, ADB's capacity building technical assistance in Cambodia seeks to build all three types of capacity in government.

Mainstreaming HIV Interventions in ADB Projects. Recognizing that the response to HIV and AIDS has to be multi-sectoral, ADB will integrate HIV interventions in its projects, not only in the health sector but also in other related sectors.

For example, the Rural Health Project in Viet Nam seeks to strengthen

• communication activities to help people change their behavior
• community organizations aimed at HIV prevention

Projects such as the Social Action Program and the Women's Health Project in Pakistan include HIV and AIDS control components. ADB's infrastructure projects will contain provisions for HIV prevention and control activities for construction workers. Similarly, rural development projects and education projects will include HIV prevention related activities.

Specific Projects on HIV. If the investment needs for concentrated country action on HIV and AIDS are of such magnitude that the amount clearly justifies ADB's involvement, a stand-alone HIV and AIDS project may also be considered. An HIV and AIDS project could be developed based on three important considerations:

• size of the population affected, which would include the estimated numbers of infected and the larger numbers of people at risk of infection
• demonstration of the opportunity for successfully mounting a response of such scale that has clear prospects for pushing back, containing, or heading off a more serious epidemic
• investment and foreign exchange needs essential to such response are appropriate for ADB financing. For example, recent lowering of prices of retroviral drugs for HIV may justify foreign exchange support for these relatively cheap, but still unaffordable by most DMCs, drugs