Barbados - Second HIV/AIDS Project

Page 1 PROJECT INFORMATION DOCUMENT (PID) APPRAISAL STAGE Report No.: AB3657 Project Name Barbados Second HIV/AIDS Project Region LATIN AMERICA AND CARIBBEAN Sector Health (100%) Project ID P106623 Borrower(s) GOVERNMENT OF BARBADOS Ministry of Finance Barbados Implementing Agency National HIV/AIDS Commission Dr. Carol Jacobs, Chair Dr. Alies Jordan, Director 4nd Floor East, Warrens Office Complex Warrens, St. Michael BB 12001 BARBADOS Tel (246)-310-1008; Fax (246)-421-8499 Email: ajordan@hiv-aids.gov.bb Environment Category [ ] A [ ] B [X] C [ ] FI [ ] TBD (to be determined) Date PID Prepared March 20, 2008 Date of Appraisal Authorization February 26, 2008 Date of Board Approval August 7, 2008 1. HIV/AIDS continues to be a key global development issue in all regions of the world. The Caribbean Region has the highest HIV prevalence among adults outside Sub-Saharan Africa. Barbados has an estimated prevalence rate of 1.5% in 2007. Although Barbados has achieved significant results in the prevention and control of the epidemic, HIV/AIDS is one of the main causes of burden of disease in the country. While new AIDS cases and AIDS mortality significantly declined (46% and 85%, respectively) since the advent of anti-retroviral treatment in 2001, estimated HIV prevalence continues to increase. This is due to the increasing number of new and old cases, respectively, due to the lack of adoption of safer sexual practices, and the increasing survival of people under treatment. 2. The first case of HIV/AIDS was detected in Barbados in 1984, at a time when the epidemic was confined to men who have sex with men (MSM). However, the number of reported HIV cases continued to rise, particularly among self-reported heterosexual men and women of reproductive age. There are about 2,100 known people living with HIV (PLHIV) in Barbados, but recent estimates suggest that the total number of infected adults may be significantly higher. In 2006, over 75% of reported infections occurred in the age group 15-49 years. In addition, there has been rapidly increasing feminization of the epidemic, with a male to female ratio of 1 in 2006. Page 2 3. Despite the numerous achievements of the national program, much remains to be done regarding HIV/AIDS and other sexually-transmitted infections (STIs) in Barbados. The single greatest gap in the HIV/AIDS and STI program is the fact that the monitoring and evaluation (M&E) system is not fully functional. Outreach for key populations at higher risk needs to be improved. Evidence from the 2001, 2003 and 2005 youth KAP surveys indicate that educational messages have been successful in raising knowledge levels but less so in affecting behavior change. While the National AIDS Program has engaged in voluntary counseling and testing (VCT), further collaboration with community groups and NGOs will make VCT more available. Social care of People living with HIV (PLHIV) also needs strengthening. Finally, multi-sector institutional roles and relations have to be further strengthened, especially between NHAC and key ministries such as the Ministries of Health, Social Care, Constituency Empowerment and Urban Development, Education, Labor and Tourism. 4. Government Strategy. The Government of Barbados (GoB) is fully committed to containing the epidemic. The government specifically requested Bank assistance in 2001, and again now, to contain the HIV epidemic. Extensive work has been done to put in place the UN