World Bank Would Fund Needle Exchanges

By Harry Dunphy
Associated Press Writer

WASHINGTON (AP), November 3 Government leaders in developing countries
must act to prevent AIDS epidemics even if that means promoting such
politically controversial programs as condom use and clean needles for drug
users, according to a World Bank report released Monday.

The report recommended fast, intensive prevention efforts in countries
where AIDS is just starting to appear, especially among people who have
many sex partners or inject drugs, saying millions of lives could be saved.
Approximately 90 percent of all HIV infections occur in developing countries.

SubSahara Africa has the most people infected with AIDS 14 million
but new evidence in the report suggests the virus may be on the verge of
exploding in parts of China, India, Eastern Europe and the former Soviet
Union.

The report does not cover the United States and other industrialized nations.

In some countries life expectancy was 10 to 20 years shorter than it would
have been in the absence of the AIDS epidemic, said Joseph Stiglitz, the
bank's chief economist and a former adviser to President Clinton.

The international lending agency is one of the largest sources of money for
AIDS prevention, having committed $632 million to 61 projects in 41 countries.

Stiglitz said the report differs from many other studies of AIDS by
focusing on how best to allocate scarce government resources and
international funding for costeffective responses to the disease.

Martha Ainsworth, a coauthor of the report, said countries that believed
AIDS would not become a problem are now experiencing serious epidemics.

"By the time many AIDS cases are observed it is too late to avert a serious
epidemic," she said. "HIV will already have spread widely."

Among those in the riskiest category are people who have unprotected sex
with many partners truck drivers, migrant workers, bar workers and the
military, the report said.

The report said programs that make it easier for injecting drug users to
get sterile needles also have been highly effective in preventing the
spread of AIDS.

Asked if the bank advocated needleexchange programs, Richard Feachem,
director of the bank's health department, said the bank's role was to
provide governments with information so they can decide. He said the bank
was prepared to pay for such programs if asked by a government.

Ainsworth and Feachem both said treatment for AIDS patients available in
the West was too expensive for developing countries. They said it was
better for available funds to be spent on prevention.