World Bank HIV/AIDS Interventions: Ex-ante and Ex-post Evaluation

iv Foreword The AIDS epidemic is one of the greatest development challenges of the 20th century. Since 1986 the World Bank has supported member country efforts to fight the epidemic in many ways, including lending, economic and sector analysis, grant support, technical assistance, and policy advice. This paper is the first comprehensive desk study of all World Bank HIV/AIDS-related activities from the perspective of public economics. It was prepared as a background paper for the recent World Bank Policy Research Report, Confronting AIDS: Public Priorities in a Global Epidemic. The paper is intended primarily for the use of World Bank staff, but we hope that it will also provide guidance to governments, other international agencies, and non-governmental agencies in the design and implementation of HIV prevention and mitigation programs. Learning from World Bank experience can help the Bank, together with its member countries, to confront the AIDS epidemic more effectively. v Abstract This paper evaluates World Bank activities to prevent and mitigate the effects of AIDS in all regions of the developing world during fiscal years 1986 to 1996. It first prioritizes HIV-prevention and treatment interventions using the principles of public economics. Based on this framework, it assesses the appropriateness of Bank lending and grants, Bank Country Assistance Strategies, and country economic and sector work. While the Bank provided extensive assistance for efforts to collect information (surveillance and behavioral studies), support was less extensive for interventions that focus on reducing risky behaviors of those at highest risk for contracting and transmitting HIV. Few of the projects reviewed in the paper relied on strong economic analysis in ex-ante or ex-post evaluation. These findings suggest two primary challenges for the World Bank: (i) to focus its support for HIV prevention interventions that reach groups at highest risk to contract and spread HIV; and (ii) to improve the economic analysis used in preparing Bank HIV-related projects and in evaluating their effectiveness.