1. How has ADB's overall strategic direction with regards to meeting the AIDS challenge in Asia changed through the years?
Over the last five years, ADB's strategy to prevent HIV in Asia and the Pacific has consistently focused on prevention and mitigation activities that support our clients to achieve the MDGs, universal access to HIV prevention and support services, and ADB's long-term strategic objectives. ADB leverages HIV prevention activities in those areas where it has comparative advantages, including mitigation of transmission in infrastructure development, and in trade and transport corridors. Thus, ADB ensures integration of HIV concerns into its core business, complementing the work of health technical agencies and non-governmental organizations.
ADB has invested in more systematic approaches and evidence-based programming in order to identify HIV risks at earlier stages in the project cycle. We are also committed to knowledge sharing inside and outside ADB on good practices in reducing HIV risks. This regional leadership role was recognized and formalized in the Joint Initiative for Mitigation of HIV/AIDS Risks in the Infrastructure Sector in 2006 signed between ADB, African Development Bank, KfW, DFID, JICA, and World Bank.
2. What will the new strategic directions focus on for the next five years?
The five-year plan for Strategic Directions for HIV was approved in 2011 and focuses on consolidating and reinforcing our previous prevention and mitigation strategies while increasing the evidence basis for our actions. Overall, ADB's approach of complementing other partners' activities and demonstrating good practices that can be cost-effectively replicated and scaled up is underscored. In addition, the new Directions have a stronger focus on key affected populations as a means of more efficiently targeting action in regional cooperation and infrastructure projects. Areas for continued emphasis include strengthening of innovative and strategic partnerships that leverage domestic and international support. A good example is our program in Papua New Guinea where we work with private and public sectors, and civil society to support HIV prevention and support services. Another area is mitigating HIV/AIDS risks and vulnerabilities associated with infrastructure projects. Our experiences from the GMS region and our efforts with colleagues working in the transport sector who have recognized their role in contributing to the fight against the disease are particularly important to highlight in this context. We are also keen to increase our analytical work in key areas of HIV given our earlier successes in utilizing data and analysis to affect political and financial commitment to address HIV/AIDS in the region.
More specifically, the new Strategic Directions for 2011-2015, are focused on three priority areas:
- mitigating HIV and AIDS risks and vulnerability along economic corridors;
- promoting regional cooperation to control and reverse the spread of HIV, specifically for those most at risk; and
- supporting HIV/AIDS-related impact studies on economics, gender, and poverty in support of evidence-based policy dialogue.
3. Have there been sufficient responses from DMCs and donor countries with regards to effectively tackling this problem?
No. UNAIDS and Kaiser Foundation recently reported that external resources for HIV/AIDS programming dropped by 10% in 2010. Last week, the Global Fund for AIDS, Tuberculoses and Malaria reported on serious financial shortcomings with implications for those living with the virus. A more complex and longstanding problem in our region is the generally low health expenditures as share of GDP. If Governments do not increase their budgetary commitment to the health sector, many of the Asian and Pacific countries are unlikely to meet the agreed global and regional health commitments.
More importantly, our region has the strength and wealth with booming economies and massive reserves. Targeted implementation of low-cost and high impact HIV prevention programs makes strong economic sense, as they can lessen impacts on societies as a whole. With a limited resource envelope, the region must develop and implement responses that are based upon evidence.
4. What projects is ADB involved in or planning to support to help maintain a low prevalence situation of HIV and AIDS in Asia and the Pacific?
ADB is primarily supporting HIV prevention programs associated with infrastructure projects. ADB also supports regional initiatives like the regional aids data hub (www.aidsdatahub.org) and unique cross-border initiatives through our regional programs, primarily in the Greater Mekong sub-region. We have also supported specific capacity building programs for costing of national HIV/AIDS programs in partnership with UNAIDS.
5. Is the goal of "zero new infections" an achievable target? What are the other factors that may make this goal difficult to attain?
It's a very ambitious target that must be considered among many other key challenges in the health sector. Our region is still a low prevalence setting --- but key affected populations often have much higher prevalence. If we allocate resources towards low-cost and high impact initiatives, with active involvement of those affected and infected, we may be able to reach the target of zero new infections. The key must be to keep those who are HIV negative to remain HIV negative while providing treatment services for the key affected populations.