62612

         Spanish Trust Fund for Impact Evaluation and Results-based Management in
                                 Human Development Sectors
                                          (SIEF)
                                           Cluster Fund

                      HIV/AIDS Prevention

The Spanish Trust Fund for Impact Evaluation (SIEF) is a €10.4
million program funded by Spain, complemented with a $1.5
million from the United Kingdom, to support the World Bank in
evaluating the impact of innovative programs to improve human
development (HD) outcomes. The SIEF supports prospective,
rigorous evaluations in eligible developing countries, impact
evaluation training, publications, and dissemination of results.
Policy questions
The HIV/AIDS prevention cluster will address a number of
critical questions:
          What are the impacts of Antiretroviral Therapy (ART) on
          the welfare of patients and their family members, including lives saved, health outcomes,
          labor participation, hours worked, and schooling of children?
          What effects does ART access have on HIV transmission and prevention?
          What are the most cost effective means of preventing HIV/AIDS and/or sexually
          transmitted infections (STIs)?
          How does sexual behavior change in response to HIV prevention interventions?


Background & Context

Globally, an estimated 32.2 million people were living with HIV/AIDS at the end of 2007.At
least 2.1 million people lost their lives to AIDS, and an estimated 2.5 million became newly
infected that same year. The global epicenter of the AIDS pandemic is in Africa, where an
estimated 22.5 million people were living with HIV at the end of 2006, and approximately 1.7
million new infections occurred during that year.1 Young people, aged 15-25, are at greatest risk.

The need to identify effective prevention and treatment interventions is critical in the global
effort to reverse the trend of HIV/AIDS infections. The use of condoms, reduction in the number
of partners, and abstinence are three prominent mechanisms by which HIV prevention is sought.
Prevention
At its core, the global AIDS epidemic is fueled by risky sexual behavior. Over 80% of HIV
infections occur through sexual contact with an infected partner (Askew and Berer, 2003) and
could have been avoided through the adoption of safer sexual behaviors including condom use,
reduction in the number and concurrency of sexual partners, or abstinence. A great deal of policy
dialogue has been devoted to supporting HIV prevention programs; however, little evidence

1
    UNAIDS (2007). "UNAIDS/WHO AIDS Epidemic Update: December 2007."
exists to demonstrate the impact of prevention interventions. The impact that various prevention
strategies have on HIV and STIs, and the relative effectiveness of programs are important
sources of evidence for developing successful HIV prevention programs. Identifying cost-
effective means of preventing HIV infections is essential to establishing a stronger policy
framework for slowing the spread of HIV and other STIs.

Although a number of countries are experimenting with prevention mechanisms, one reason for a
lack of evidence is that few rigorous impact evaluations of HIV prevention programs have been
launched. Such evidence is crucial for designing effective prevention programs and policies. This
cluster proposes rigorous, prospective randomized evaluations of HIV prevention interventions.

SIEF-funded Impact Evaluations
Lesotho – This IE is evaluating the effectiveness of an information campaign to prevent HIV
infection aimed at youth in Lesotho. The intervention is a unique Lesotho government-designed
program, which uses a communication tool to highlight the many issues that affect the spread of
HIV (e.g. circumcision, prevention methods such as abstinence, fidelity and condom use,
polygamy, sexual abuse of women and children, etc). The evaluation is examining variations in
the communication tool; namely differences in prevention messages of abstinence and fidelity
versus condoms and safe sex.
Malawi – This IE is studying a program which provides incentives (in the form of school fees
and cash transfers) to young girls who have recently dropped out of school as well as girls
currently in school. This study is evaluating the causal effect of income on HIV risk directly, as
well as through its effect on schooling using a carefully designed cash transfer program for
young women, which is conditional on school attendance.
Tanzania – This IE is studying the use of conditional cash transfers as a prevention mechanism
for HIV and other STIs among people aged 18-29 in a remote rural area of Tanzania. Several
sub-group analyses will help inform decisions around targeting and scaling up: differences in
responsiveness of males and females to the intervention; of different age groups; and of different
socioeconomic groups. While CCTs have been used in health and social policy settings, they
have not been evaluated for their effectiveness as an AIDS prevention intervention.



HIV/AIDS Prevention                                                Country        Budget
Evaluating the impact of HIV prevention campaign for the youth:
Abstinence, Fidelity and Safe Sex                                 Lesotho    $             186,800
Conditional Cash Transfers, Schooling, and HIV Risk               Malawi     $             274,500
Evaluating Conditional Cash Transfers to prevent HIV and other
sexually transmitted infections (STIs)                            Tanzania   $             290,400
                                                                     Total   $             751,700




                                        www.worldbank.org/sief                                  2