Scaling up Multisectoral Approaches to Combating HIV and AIDS

Introduction The AIDS pandemic is a global crisis with impacts that will be felt for decades to come, demanding massive responses at many levels. Such responses need to continue to be grounded in the three core pillars of prevention, care and treatment, and mitigation. But these responses need to be much larger in scale, far more broadly based, and better connected so as to better match the scale, breadth, and inter-connectedness of the pandemic's causes and impacts. Alarmingly, programs aimed at preventing the spread of HIV reach fewer than one in five people who need them (UNAIDS 2004a). Fewer than 12 percent of the 6 million people estimated to be in immediate need for treatment are receiving it (WHO 2005). Only a tiny fraction of households that are affected by the pandemic are receiving any kind of support. Programs aimed at combating the epidemic generally tend to be concentrated in urban areas. This deplorable situation is not caused by lack of knowledge of what needs to be done in prevention, care and treatment, and mitigation. On many of these issues there are well-codified scientific and operational guidelines. A few such examples include guidelines on combating the epidemic among men having sex with men (Anyamele et al. 2005; UNAIDS 1998) and HIV/AIDS care and treatment guidelines for resource-limited settings (WHO 2004). Several small-and medium-scale programs are successfully addressing many other issues, such as home-based care for people living with HIV (PLWHAs) or support to street children. The first part of this chapter focuses on challenges to scaling up. The second part discusses World Bank's experience with scaling up its multisectoral HIV/AIDS