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Since 1999, many African governments have launched programs to offer short-course antiretroviral drug regimens to reduce mother-to child transmission of HIV. HIV testing in prenatal care is the gateway to these antiretroviral regimens. Pilot projects in Africa show an uptake of antiretroviral drugs in 8% to 50% of pregnant women presumed to be HIV infected; often, a minority of eligible women in care received these regimens. Use of lay counselors and rapid onsite HIV testing may alleviate health service barriers. Community education to promote voluntary counseling and testing, which involves men, is the long-term solution. In the short term, possibilities to enhance delivery of an effective intervention include group pretest counseling, universal offer of testing with women having the right to “opt out,” universal treatment (mass treatment for those whose HIV status is not determined by voluntary counseling and testing), universal testing with women having the right to “opt out” of learning their test results, and mass treatment for all without testing.

Pakistan has made strides over the last decade in its Acquired Immunodeficiency Syndrome (AIDS) response, with active surveillance, considerable research, both governmental and non?governmental prevention and care activities, and treatment since 2005 to 2006. However, the Human Immunodeficiency Virus (HIV) prevalence among People Who Inject Drugs (PWID) has not declined, coverage of current prevention and treatment programs remains limited and the gains made to date are threatened by internal and external factors. This report attempts to review and synthesize available data on HIV in Pakistan and to use these data to suggest strategic priorities for the next phase of the HIV response in an effort to improve the allocative efficiency of resources and effective and efficient implementation of the response. This report presents an integrated model for HIV services delivery that depicts a continuum of care from prevention outreach to treatment with a focus on evidence based interventions and strong linkages. It describes three potential models for Volunteer Counseling and Testing (VCT) services for most at risk populations that increase outreach and engagement with PWID, hijra communities, and Male Sex Workers (MSWs), and their clients. It also places heavy emphasis on evidence based approaches to prevention including expanding treatment for High Risk Groups (HRGs) and improving the linkages for HIV positive and HIV negative PWID for drug treatment services, such as Methadone Maintenance Therapy (MMT), and outlines the steps for an evidenced based, effective and efficient policy response at a time of shrinking resources for HIV in overall low prevalence settings. This report is organized as follows: chapter one gives introduction; chapter two presents epidemiology methods; chapter three gives country context; chapter four presents status of HIV epidemic; chapter five gives summary of key findings; chapter six deals with systems response to HIV and AIDS in Pakistan; chapter seven gives key policy recommendations; and chapter eight gives conclusion.

The principal purpose of this Global Program Review (GPR) is to learn lessons from the experience of the Global Fund and its interaction with the Bank in three areas: (a) the design and operation of large global partnership programs like the Global Fund that are financing country-level investments, (b) the engagement of the World Bank with these partnership programs, and (c) the evaluation of these programs. The Review has an intensive focus on the Bank's engagement with the Global Fund at the country level because of the potential for competition or collaboration between Global Fund-supported activities and the Bank's lending operations at the country level. Therefore, it also focuses on the design and operation of the Global Fund-supported activities at the country level. This review was initiated before the high-level independent review panel on fiduciary controls and oversight mechanisms of the Global Fund was commissioned in February 2011, and it was drafted before their final report, turning the page from emergency to sustainability, was issued on September 19, 2011. While the two studies are complementary and overlap to some extent, they were conducted independently of each other, for different audiences, and for different purposes.

This study outlines the initial challenge presented by the HIV/AIDS epidemic, describes Djibouti's response, reviews the results achieved and the enabling factors in curbing the spread of the epidemic, and identifies remaining challenges. Between 2002 and 2008, HIV prevalence among young pregnant women aged 15-24 was reduced from 2.7 percent to 1.9 percent and among sentinel surveillance groups from 2.5 percent to 1.9 percent. HIV prevalence among tuberculosis patients was reduced from an estimated 22 percent to 12 percent. Condom use during last intercourse outside marriage increased from 27 percent to 55 percent and reached 95 percent among sex workers. Among the general population, awareness of HIV/AIDS increased to 95 percent and knowledge about transmission and prevention rose to 50 percent. Political commitment, engagement of community and religious leaders, rigorous communication, social marketing and the provision of an integrated package of medical and social services, and donor harmonization were among the key factors that contributed to the achievement of these results. Despite these impressive results in a relatively short period, Djibouti still has to address several challenges and consolidate program gains, but most importantly, funds are being mobilized from government resources to sustain the national AIDS control program.

This paper summarizes the key findings of an 'After Action Review' (AAR) that reflects a decade of experience in designing and implementing ten HIV/AIDS projects in the Caribbean, financed by the World Bank. The objective is to identify what worked (and what didn't) in the project approach, design and implementation, distilling useful lessons for other projects in small states.

This paper summarizes key findings of the epidemiological, response and policy synthesis analysis carried out in Honduras in 2007, as part of the preparation of the new national HIV/AIDS strategy, PENSIDA III, (National Strategic Plan to Fight HIV/AIDS - Plan Estrategico Nacional de Lucha Contra el VIH/SIDA) 2008-2012. It presents the most recent data on HIV prevalence, and the results of models that estimate sources of infection and likely patterns and trends in future prevalence. The paper also describes how these data and projections have been incorporated into the design of Honduras' response to the epidemic, grounding PENSIDA III's strategic direction in the data on the epidemic and response in Honduras, building and improving on previous experience.

In spite of recent advances in treatment and care available in most developed countries, the HIV/AIDS pandemic continues to spread throughout the developing world. Structural inequalities continue to fuel the epidemic in all societies, and HIV infection has increasingly been concentrated in the poorest, most marginalized sectors of society in all countries. The relationship between HIV/AIDS and social and economic development has therefore become a central point in policy discussions about the most effective responses to the epidemic. Important progress has been made in recent United Nations initiatives. Maintaining long-term commitment to initiatives such as the Global Fund to Fight AIDS, Tuberculosis and Malaria is especially important in the wake of September 11 and ensuing events, which threaten to redirect necessary resources to seemingly more urgent security concerns.