Page 1 PROJECT INFORMATION DOCUMENT (PID) CONCEPT STAGE Report No.: AB653 Project Name ST. VINCENT SNF THE GRENADINES HIV/AIDS Region LATIN AMERICA AND CARIBBEAN Sector Health (100%) Project ID P076799 Borrower(s) ST. VINCENT Implementing Agency Mrs. Verlene Saunders Permanent Secretary of Health and Environment Ministry of Health and the Environment Administrative Centre Kingstown, St. Vincent & the Grenadines Tel: 784-456-1111 (Ext. 511/512) or 784-457-2586 Fax: 784 457-2684 E-mail : mohesvg@vincysurf.com, Environment Category [ ] A [X] B [ ] C [ ] FI [ ] TBD (to be determined) Safeguard Classification [ ] S 1 [ ] S 2 [ ] S 3 [ ] S F [ ] TBD (to be determined) Date PID Prepared February 2, 2004 Estimated Date of Appraisal Authorization March 27, 2004 Estimated Date of Board Approval June 25, 2004 1. Key development issues and rationale for Bank involvement The Caribbean region is currently second to the Africa region in terms of the adult prevalence rates of HIV infection. The Caribbean Epidemiological Center (CAREC) and the Centers for Disease Control (CDC) estimate that the CAREC member countries 1 have a total of 109,395 people living with HIV/AIDS within a population of 7.01 million resulting in a prevalence rate of 1.6%. The data on the trends of the epidemic in St. Vincent like many other countries in the region has some limitations, nonetheless it indicates a growing problem. CAREC and CDC estimate that the adult prevalence rate of HIV/AIDS in St. Vincent was 0.9% at the end of 2001. A total of 1,002 people are living with HIV/AIDS most of whom are aged between 15 and 49 years. Women account for 31% of adults living with HIV/AIDS. The growing feminization of the epidemic is of concern especially in a country where a significant number of households are headed by women (1991 census, 67.7%). The age distribution of HIV/AIDS follows patterns experienced in other countries: most cases of HIV positive (60%) are in the 25-55 age group; the age group 15-24 years account for 19.7%, those over 50 years 8% and the 5-14 years account for 0.7%. The infected cut across a broad spectrum of the population: both the unemployed and the employed (entertainment and service sectors, farming, laborers, protection officers, fishermen, vendors, sailors, shop assistants, teachers, students and health care workers). While, HIV/AIDS prevalence in St. Vincent is not generalized in the population, the population in the Caribbean is highly mobile and the epidemic is 1 CAREC member countries include: Antigua and Barbuda, Dominica, Grenada, St. Kitts and Nevis, St. Lucia, St. Vincent and Grenadines, Anguilla, Bermuda, Cayman Islands, Montserrat, Netherlands Antilles and Aruba, Turks and Caicos, Virgin Islands-UK, Bahamas, Barbados, Belize, Guyana, Jamaica, Suriname and Trinidad and Tobago. Page 2 growing fast in a number of other countries in the region. The Government therefore, needs to take action to prevent the epidemic escalating and undermining the achievements in socio-economic development as it has done in other countries. The Government Response to the Epidemic. The Government with the assistance of the World Health Organization established a response program following the identification of the first HIV/AIDS case in 1984. The program included information, education and communication (IEC), condom distribution, blood screening, testing and counseling, antenatal surveillance and patient care. Recently the program has expanded to include anti-retroviral therapy. While many interventions have been undertaken, it became apparent to the Government that it needed to review its strategic response to the epidemic for a greater impact. Based on a situation analysis and broad consultative process of all key stakeholders, the Government prepared the National HIV/AIDS Strategic Plan to cover the period 2003-2008. The plan is based on the Caribbean Strategic Plan of Action for HIV/AIDS. The Plan proposes six main strategies: (1) Strengthening inter-sectoral management, organizational structures and institutional capacity; (2) Designing and implementing care support and treatment programs for PLWHA and their families; (3) Developing and implementing HIV/AIDS/STI Prevention and Control Programs with priority given to youth and high risk and vulnerable groups; (4) Conducting research and training; (5) Upgrading surveillance systems; and, (6) Implementing Advocacy programs. The proposed St. Vincent HIV/AIDS Prevention and Control Project will support the implementation of this National HIV/AIDS strategic plan. The CAS for the Eastern Caribbean Sub-Region of June 2001 (Document No. 22205-LAC, last discussed on June 8, 2001), identifies HIV/AIDS prevention and control as a priority that requires urgent Bank support. The Bank can bring both its experience with HIV/AIDS programs and additional resources to support St. Vincent Government step scale up its response. In addition, St. Vincent expects to receive some funding from the Global Fund through the joint project prepared for the OECS countries with the assistance of the Clinton Foundation. 2. Proposed objective(s) The project will support control of the spread of HIV/AIDS and mitigation of its impact. It will support targeted interventions for high risk groups and non-targeted interventions for the general population. It is expected that the implementation of the project will lead to: a) increased awareness of HIV/AIDS and use of prevention services by high risk groups and the general; b) increase in the number of PLWHA and their families who are receiving care and support; and, c) strengthening of both public sector and civil society capacity to respond to HIV/AIDS. 3. Preliminary description The project will be prepared under the third phase of the World Bank Multi-country HIV/AIDS Prevention and Control APL for the Caribbean. A project of US$ 7 million is proposed with four components: Component 1: Civil Society Organizations Initiatives (US$ 1.0 million). This component will finance HIV/AIDS prevention, care and support activities of communities, Non-Government Organizations (NGOs), Faith-based organizations, women’s organizations and private sector organizations. It will also support strengthening the implementation capacity of these organizations by: providing training in information education and communication (IEC)/behavior change communication (BCC); home-based care; other technical skills; and, project management (including financial management, and monitoring and evaluation). Page 3 Component 2: Line ministry response (US$ 2.0 million). This component will support the response of the non-health sector ministries to HIV/AIDS. There are basic cross-cutting HIV/AIDS activities that all ministries would be expected to implement. They include: (a) development and implementation of workplace HIV/AIDS policies; (b) IEC/BCC for HIV/AIDS and STDs; (b) condom promotion and distribution; (c) advocacy to reduce stigmatization and discrimination; and, (d) establishment of support groups for HIV/AIDS. There are also HIV/AIDS related interventions that are specific to a particular ministry’s external clients, for example, pupils, students and teachers, for the Ministry of Education; the hotel industry for the Ministry of Tourism; and, the uniformed forces and the prison population for the Ministry of Home Affairs. A number of ministries are expected to lead the way in the first year of project implementation: (a) Education, Youth and Sports; (b) Tourism and Culture; and (c) Social Development. Component 3: Strengthening the health sector response to HIV/AIDS (US$ 3.0 million). The project will support the strengthening and expanding of health sector HIV/AIDS related services for prevention, treatment, care and support, which will include: voluntary counseling and testing (VCT), condom promotion and provision; introduction of syndromic management of sexually transmitted diseases, management of opportunistic infections, home-based care for PLWHA, prevention of mother to child transmission of HIV including treatment of the mother and family (PMTCT-Plus), support of nutritional interventions for PLWHA, introduction of anti-retroviral treatment (ART), strengthening of laboratory capacity, training of health workers to respond to HIV/AIDS, blood safety and medical waste management. The capacity building and strengthening of this sector will contribute to the overall strengthening of the health care system. Component 4: Strengthening institutional capacity for program management (US$1.0 million). This component will support the building of institutional capacity for program coordination, facilitation and management. In particular, it will fund the operations of the National HIV/AIDS policy making body (to be formed), the National HIV/AIDS Program and the project coordination unit (PCU). The National HIV/AIDS Program will be the institution that will be responsible for day to day running of project activities, while the PCU will be responsible for financial management and procurement under the direction of the National HIV/AIDS Program. 4. Safeguard policies that might apply The safeguard policies regarding environmental assessment may apply to this project due to the medical waste that will be produced by health interventions supported by this project. A medical waste management plan for the country was prepared in 2001 and would satisfy the safeguard requirement, subject to clearance by the ESSD. 5. Tentative financing Source: ($m.) BORROWER/RECIPIENT 1.4 INTERNATIONAL BANK FOR RECONSTRUCTION AND DEVELOPMENT 2.8 INTERNATIONAL DEVELOPMENT ASSOCIATION 1.4 IDA GRANT FOR HIV/AIDS 1.4 Total 7 6. Contact point Contact: Mary T. Mulusa Title: Sr Public Health Spec. Tel: (202) 473-1937 Page 4 Fax: (202) 522 0050 Email: Mmulusa@worldbank.org