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Integrated Safeguards Data Sheet                  Report No. 
(AC1145)
 
Section I 
–
Basic Information 
Date ISDS Prepared/Updated: Prepared:  December 20, 2004 .  
A. Basic Project Data 
(from PDS) 
I.A.1. Project Statistics 
COUNTRY: Central America 
PROJECT ID: P082243 
PROJECT: 
Regional HIV/AIDS Project
 
TTL: Marcelo Bortman  
APPRAISAL DATE: January 10, 2005 
IBRD AMOUNT ($m):  
BOARD DATE: March 29, 2005 
IDA AMOUNT ($m): 8 M 
MANAGING UNIT: 
LCSHH
 
SECTOR: Health (100%) 
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LENDING INSTRUMENTS: 
Grant
 STATUS: 
 
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1.  Project Objectives 
 
The project development objective is to provide knowledge and tools to decision makers in all countries in the 
region to manage and control HIV/AIDS and other opportunistic infections.  This would be achieved through 
providing regional countries better access to high quality diagnosis of HIV/AIDS infections, a regional second 
generation surveillance system for the epidemics, enhancing the regional capability for cross/fertilization of better 
practices in epidemic prevention and control, and reducing the vulnerability to HIV/AIDS of mobile populations. 
 
The key project outcome will be the development of a regional framework to prevent and control the HIV/AIDS 
epidemic, including: prevention and management strategies; respect and promotion of human rights; access to HIV 
testing, counseling and integrated treatment; HIV/AIDS Regional Surveillance System, large-scale economic 
approach to purchase ARV, lab tests and other related medical supplies. This framework will constitute a Regional 
Action Plan agreed by COMISCA or the Presidents’ Summit.   
 
2.  Project Description 
 
Lending instrument 
 
The proposed instrument is an IDA sector investment grant provided to the Central American Region (Costa Rica, 
El Salvador, Guatemala, Honduras, Nicaragua and Panama) represented by the Central American Secretariat for 
Social Integration (SISCA), an arm of the permanent entity that manages the integration process (SICA) agreed by 
the heads of state of its member countries. 
 
The Indivisibility Argument.
The proposed project was designed to support the implementation of a regional 
indivisible program to finance region-wide and non-country specific HIV/AIDS prevention and control measures.   
 
The prevention and control of HIV/AIDS epidemic has been focused on national projects and initiatives that have 
reached their objectives yet because of: structural problems links to poor incomes and unequal economic 
development, large amount of mobile population crossing permeable borders, tourism as one of the leading 
economic base with strong seasonal fluctuations, and the absence of a Regional Action Plan to define 
prevention 
and manage
 strategies and coordinated interventions. Therefore, HIV/AIDS prevention and control efforts in 
Central America require not only national programs but also regional strategies and actions that would reduce the 
risks of gaps in the prevention and control of the epidemic. A regional response to the AIDS epidemic will deal 
with the needs of coordination of the limited resources and available capabilities in many of the countries of the 
Region and would help to bridge the gap between countries. The proposed project builds on the strengths of 
Central America regional cooperation in health related issues. The Central American Integration System and the 
Central American Council of Minister of Health have worked actively on building regional frameworks, and 
sharing knowledge and expertise across countries. 
 
The benefits of the regional activities this project would support would extend directly to Central American 
countries that have different standing status with the World Bank.  This include (i) IBRD-only countries 
(Guatemala and Panama); (ii) graduated IBRD-only countries (Costa Rica and El Salvador); and (iii) IDA-only 
countries (Honduras and Nicaragua).  Notwithstanding the above, the proposed grant is fully justified in view of 
its regional focus and expected benefits since grant-financed activities would not benefit or be attributable to any 
one country, but to the Region as a whole. 
 
The proposed regional project is consistent with Sector Investment IDA Grants because it addresses a regional 
HIV/AIDS issue, promotes a public good of multinational scope, provides services to populations beyond the 
reach of national programs, scaling up existing initiatives to support mobile populations, and realizing economies 
of scale that would not be practical to attain through country-level action.  Additionally, the project has been 
endorsed by the governments of the countries, and key regional institutions (COMISCA, SISCA and SICA) have 
appropriate policies, procedures and regulations in place to enable them to participate effectively in project 
implementation. Furthermore, these agencies have an adequate fiduciary framework in place to comply with IDA 
requirements. 
 
3
Project Components
1
Second generation surveillance combines several data streams including Aids case surveillance, HIV zero 
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I.A.4. Project Location 
The HIV/AIDS Regional
 
Reference Diagnostic Center will be located at the Commemorative Gorgas Institute,  
town of Calidonia,  District of Panama, Province of Panama.   
 
B1. Check Environmental Classification 
A
[
], B [
X
], C [ ], FI [ ], TBD [ ] 
Comments:
 
The  
Commemorative
 Gorgas Institute already exists and is in operation. The project will support 
minor construction works, and the increase on production of health care waste is expected due to the 
extension of its services to a regional category . 
 
C. Safeguard Policies Triggered 
Click on Policy reference number for full policy
 
I.C1. Table on applicability 
Yes 
No 
TBD 
Environmental Assessment (OP/BP/GP 4.01) 
[X] 
[ ] 
[ ] 
Forestry (OP/GP 4.36) 
[ ] 
[X] 
[ ] 
Natural Habitats (OP/BP 4.04) 
[] 
[X] 
[ ] 
Safety of Dams (OP/BP 4.37) 
[] 
[X] 
[ ] 
Pest Management (OP 4.09) 
[] 
[X] 
[ ] 
Involuntary Resettlement (OD 4.30) 
[] 
[X] 
[ ] 
Indigenous Peoples (OD 4.20) 
[X] 
[X] 
[ ] 
Cultural Property (OPN 11.03) 
[] 
[X] 
[ ] 
Projects in Disputed Areas (OP/BP/GP 7.60)
*
[] [X] 
[ 
] 
Projects on International Waterways (OP/BP/GP 7.50)  
[] 
[X] 
[ ] 
prevalence surveillance, STI surveillance, and behavioral surveillance, into a comprehensive data stream. 
*
By supporting the proposed project, the Bank does not intend to prejudice the final determination of the 
 
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Section II 
–
Key Safeguard Issues and Their Management 
II.D. Summary of Key Safeguard Issues 
II.D.1a. Describe any safeguard issues and impacts associated with the proposed project. Identify and 
describe any potential large scale, significant and/or irreversible impacts. 
O.P. 4.01 Environmental Assessment 
The Gorgas Institute has prepared an environmental impact assessment study to cover the expansion in 2001.  This 
plan covers activities related to the expansion of and optimization of medical services to be provided for local 
population. The Institute has its own health waste care management plan for service expansion, which includes: 
sorting, handling, transportation, immunization and disposal of  health care waste. Besides the current health waste 
management plan currently under implementation, the institute has decided to expand and organize its procedures 
to manage the expected demand of health care waste. The new version includes estimates on the increase on health 
care waste due to the new services to be provided.  
The health care waste management plan focuses on a set of procedures  to enhance the quality of management of  
new volumes and sources of  waste. As a standard practice, the plan will include training and awareness activities 
for involved personnel. Indicators to monitor its implementation will also be developed and enforced through 
Bank supervision activities. 
As a practice the Gorgas Institute has its own procedures on how to handle construction activities. This plan is 
very comprehensive and aims at protecting the quality of the surrounding environment.  
 
O. D. 4.20  Indigenous Peoples
Although a decision had been made by QAT at the PCN stage that the O.D. 4.20 would not be triggered, this was 
reconsidered after the project’s detailed design became clearer. 
A
social assessment of the current situation of Indigenous Peoples and Afro-descendants in the project area is 
being carried out with the purpose of better informing the project design.  The assessment includes a desk review 
of the situation of Indigenous and Afro-descendant peoples with regard to the epidemic in the project region, and 
consultations with the most affected ethnic group, the Garifuna, in Honduras.  Having tested the methodology, 
further assessments in different countries will be carried out under implementation. The desk review will seek to  
(a) identify the legal mechanisms, regulations related to access to civil rights, medical assistance and counseling; 
(b) address the institutional aspects of HIV/AIDS prevention, and (c) identify bi and multinational interventions 
currently in operation. The field consultations will seek to: (a) map the incidence/severity of the HIV/AIDS 
epidemics among those groups, particularly among mobile populations; (b) identify the currently used surveillance 
mechanisms across the regions and across countries; (c) identify the supplied services and strategies which are 
considered successful by the users and assess satisfaction/ dissatisfaction; (d) and address important cultural or 
behavior modification issues such as stigmatization and discrimination in public areas, in the workplace, etc. 
OPN 11.03 Cultural Property
The Gorgas Institute is located in a National Monument Building. As no major renovations of the current facilities 
are expected, this policy is not triggered. Moreover, none of the works related to the intervention  will affect the 
cultural value  of the infrastructure.
 
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II.D.1b. Describe any potential cumulative impacts due to application of more than one safeguard policy 
or
due
to multiple project component.  
·
The increase in the amount of health care waste generated by the expansion of the services.  
II.D.1c Describe any potential long term impacts due to anticipated future activities in the project area. 
·
.
The increase in the amount of health care waste generated by the expansion of the services. 
II.D.2. In light of 1, describe the 
proposed treatment of alternatives
 (if required) 
Several location alternatives were studied by the stakeholders in Central America for the new laboratory. 
The Gorgas institute was selected among  6 laboratories which could have provided the regional 
reference services because it was evaluated as the one with more technical capacities, including human 
resources, equipment, framework and experience as a regional lab for Central America. 
II.D.3. Describe arrangement for the borrower to address safeguard issues 
This project aims at improving the quantity and the quality of services being provided by the Gorgas Institute as 
Regional laboratory to monitor and manage HIV/AIDS in the central America Region. The environmental 
impacts associated to this project relate to the increase of health care waste management and the impact caused 
by minor construction activities to take place because of this project.  
The Gorgas Institute currently has into its procedures guidelines for construction activities. These guidelines 
aims at mitigating environmental impact associated to construction activities
.
In the case of the health care waste, the institute currently has a set of procedures to manage this waste. The 
plan includes sorting, packing, handling, transporting and disposal of waste. Despite the existence of these 
procedures, the Institute will produce an enhanced version of its current plan to address the expansion of its 
services. This plan will be disclosed according to Bank’s disclosure policy before appraisal.  
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II.D.4. Identify the key stakeholders and describe the mechanisms for consultation and disclosure on 
safeguard policies, with an emphasis on potentially affected people. 
Prior to granting the first environmental license for the institute a consultation process was held in 2001. Through 
this process the community endorsed its expansion noting especial interest on the cultural and heritage values of 
the current building. As explained above this building will not suffer any modifications from this project
.
As part of the social assessment with ethnic population in the project area, workshops, focus groups and 
interviews would be carried out with the Garifuna in Honduras, who are the most affected by the spread 
of
HIV/AIDS.
 
Other groups, particularly across borders, will have multiple opportunities to participate 
in workshops planned during project implementation with policy-makers as well as organizations 
working on prevention of the epidemics, and representations of vulnerable groups: MSM, CSW, truck 
drivers, seasonal mobile population, etc.  
E. Safeguards Classification
 (select one).
 Category is determined by the highest impact in any policy. 
Or on basis of cumulative impacts from multiple safeguards. Whenever an individual safeguard policy is 
triggered the provisions of that policy apply. 
[
]
S
1
.
–
Significant, cumulative and/or irreversible impacts; or significant technical and institutional risks 
in management of one or more safeguard areas  
[
X
]
S
2
.
–
One or more safeguard policies are triggered, but effects are limited in their impact and are 
technically and institutionally manageable 
[
]
S
3
.
–
No safeguard issues 
[
]
S
F
–
Financial intermediary projects, social development funds, community driven development or 
similar projects which require a safeguard framework or programmatic approach to address safeguard 
issues. 
F. Disclosure Requirements                    Expected Date Actual Date 
Environmental Assessment/Analysis/Management Plan:  
Date of receipt by the Bank 
10/ 14/04    12/29/04 
Date of “in-country” disclosure 
                   01/07/05 
Date of submission to InfoShop 
                   01/04/05 
For category A projects, date of distributing the Executive Summary of the EA to the Executive 
Directors
 
…/…/…      …/…/… or N/A 
Resettlement Action Plan/Framework: 
Date of receipt by the Bank 
…/…/…      …/…/… or N/A 
Date of “in-country” disclosure 
…/…/…      …/…/…  or N/A 
Date of submission to InfoShop 
…/…/…      …/…/…  or N/A 
Indigenous Peoples Development Plan/Framework:  
Date of receipt by the Bank 
…/…/…      …/…/…  or N/A 
Date of “in-country” disclosure 
…/…/…      …/…/…  or N/A 
Date of submission to InfoShop 
…/…/…      …/…/…  or N/A 
Pest Management Plan:  
 
Date of receipt by the Bank 
…/…/…      …/…/…  or N/A 
Date of “in-country” disclosure 
…/…/…      …/…/…  or N/A 
Date of submission to InfoShop 
…/…/…      …/…/…  or N/A 
Dam Safety Management Plan:  
  
Date of receipt by the Bank 
…/…/…      …/…/…  or N/A 
Date of “in-country” disclosure 
…/…/…      …/…/…  or N/A 
Date of submission to InfoShop
/
/
/
/
or N/A
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Signed and submitted by:  
Task Team Leader: 
Marcelo Bortman  
 
Date: 12/29/05 
Project Safeguards Specialist 1: 
Josι Ramσn Gσmez G. 
            Date: 12/29/05 
Project Safeguards Specialist 2:  
Ximena Traa-Valarezo    
Date: 12/29/05 
Approved by: 
Sector Manager 
Evangeline Javier 
 
Date: 01/04/05 
Comments 
N/A  
By supporting the proposed project, the Bank does not intend to prejudice the final determination of the 
parties' claims on the disputed areas (this disclaimer appears only for projects triggering OP/BP 8.60)