1. Transport and HIV/AIDS: A survey of the issues at stake Transport and Social Responsibility Thematic Group Julie Babinard (TUDTR) and Nina Schuler (TUDUR) May 5, 2004

2. May 5, 2004 Transport and Social Responsibility Outline & Objectives Summary review of issues and activities relating to HIV/AIDS in Transport Jocelyne do Sacramento (AFTTR): Africa region experience on HIV/AIDS in Transport Suggest areas where further work and exploration may be needed

3. May 5, 2004 Transport and Social Responsibility AIDS/HIV at a glance Unique disease (scale; incubation) A threat to public health & economic development Effects of infection felt at various levels (household; community; sector; country) Occurrence  Treatment Sexual transmission  use of condoms Bloodstream  donor screening; needles sterilization Mother to child About 42 million people living with HIV/AIDS

4. May 5, 2004 Transport and Social Responsibility 520 000 – 680 000 470 000 – 730 000 25 – 28.2 million 1.2 – 1.8 million 4.6 – 8.2 million 12 000 – 18 000 790 000 – 1.2 million 350 000 – 590 000 1.3 – 1.9 million 700 000 – 1.3 million Western Europe Sub - Saharan Africa Eastern Europe & Central Asia East Asia & Pacific Australia & New Zealand North America Caribbean Latin America North Africa & Middle East Adults & Children Estimated to be living with HIV/AIDS, end 2003 South & South-East Asia Total: 34 – 46 million Source: AIDS epidemic update, Dec. 2003. UNAIDS.

5. May 5, 2004 Transport and Social Responsibility Impact of HIV/AIDS on transport Role of transport for economic development Compromises effectiveness & reliability of transport – decline in productivity People at high risk and their families include Construction workers Employees who maintain infrastructure Workers in railways, roads, airlines … Professionals engaged in maintenance Population living along roads & highways Commercial sex workers Locally based government employees Mobile populations, refugees

6. May 5, 2004 Transport and Social Responsibility Transport and spread of HIV/AIDS Transport is major vector: Movement of people Behaviors associated with transport sector workers and transportation hubs 42% of truck drivers report indulging in commercial sex while traveling; 33% of those who have casual sex don ’ t use condoms Survey results, Poland and Lithuania border areas (World Bank, 2003)

7. Highway routesHIV prevalence prior to activitypost activity Myanmar:1997Injecting drug usersInjecting drug users Mandalay-Muse HighwayHIV+, 1996HIV+, 1998 Mandalay51%88% Lashio34%74% Muse86%92% China: 1996 constructionNumber of HIV+Number of HIV+ Yunnan-Nanning, Guangxicases 1995cases 1998 Guangxi10525 Viet Nam:Number of HIV+Number of HIV+ Highway one: Ho Chi Minh City cumulative casescumulative cases (HCMC)-Hanoi highway improvement 19971998 Hanoi51-100101-1,000 Hai Phong11-50101-1,000 HCMC>1,000>1,000 HIV Prevalence prior to and post construction/ improvement transport corridors Source: Lee-Nah Hsu (UNDP 2001)

8. May 5, 2004 Transport and Social Responsibility The Bank ’ s response in a snapshot Support HIV/AIDS prevention, care, mitigation from mandate to reduce poverty Policy dialogue, lending, analytical work, and global programs US$2.21 billion committed (Jan. 2004) Multi-Country AIDS program for Africa $1 billion to scale up existing activities and strengthen implementation Flexible and rapid funding Roughly half of MAP are allocated directly for use by communities and civil society Sub-regional and cross HIV/AIDS initiatives through MAP 2 Ex: Abidjan-Lagos Corridor Other region: Caribbean MAP; health projects focus on HIV/AIDS

9. May 5, 2004 Transport and Social Responsibility The Transport HIV/AIDS response Within World Bank SSA HIV/AIDS Abidjan-Lagos Transport Corridor project SA Indian Highway to HIV/AIDS prevention External UNDP: Multisectoral responses to Mobile Populations ’ HIV vulnerability

10. May 5, 2004 Transport and Social Responsibility Mainstreaming HIV/AIDS within transport Within World Bank SSA Ethiopian Road Sector Development Project Mali Transport Corridors Improvement Project Chad national Transport Program Support Project MENA The Djibouti International Road Corridor Rehabilitation Project EAP Cambodia Provincial and Rural Infrastructure Project (PRIP) Papua New Guinea Highlands Highway Rehabilitation Project External UNDP: Preventing HIV/AIDS on road projects in Yunnan Province, China

11. May 5, 2004 Transport and Social Responsibility Implementing HIV/AIDS measures within transport -- Recommendations A transport response should include components that consider How to change behavior/ conditions that affect behavior Which groups to target The sector entry points Food for thought: How to link transport with existing HIV/AIDS projects? How to integrate HIV/AIDS into transport projects? External partners/ resources: UNDP; USAID