Mbn hiv/aids evaluation final report Team of consultants

3. brief overview of the HIV/AIDS policy of the five CFA’s

3.1. The HIV/AIDS context in which the CFAs are operating

The historical account of AIDS dates back to the first diagnosis of AIDS cases over 20 years ago and the challenges of trying to convince the World Bank and other institutions to combat AIDS with a shift over the past ten years from a reluctance to address the crisis, to AIDS issues being internalized into development agendas. However, the number of HIV infections is not levelling off and is rapidly globalising. The increasing feminization of HIV/AIDS creates a new set of challenges to address such as gender discrimination and the collapse of households especially those headed by women. In turn, these situations produce a number of secondary effects such as a larger number of orphans and a reduction in healthy workers capable of contributing to national economic output. This loss of human capital will make it even more difficult to deliver services and carry out development initiatives such as the Millennium Development Goals (MDGs). HIV is able to spread rapidly while remaining invisible for years at a time. Because the virus is slow acting with an incubation period of many years, an HIV/AIDS epidemic is a long and slow event. By the time that even a few people with AIDS are recognised by clinical services, (or the community), many more exist whose condition has not been diagnosed or observed and there are even more who are well but infected with the virus. In short, a major problem is that once significant numbers of people begin to fall ill and die the HIV epidemic will already be far advanced. This makes the HIV/AIDS pandemic exceptional and will require, according to Peter Piot, an exceptional approach.

The HIV/AIDS pandemic can be described in stages of impact and it is considered relevant in the context of this evaluation to highlight the different stages in which the four countries that were visited find themselves.