The World Bank says HIV/AIDS will remain an unprecedented economic, social and human challenge in sub-Saharan Africa for years to come. A new report by the bank calls on African nations to increase efforts at slowing or preventing HIV infection. It estimates there are 22-and-a-half-million people on the continent living with HIV/AIDS, and it says the disease is the leading cause of premature death.

Elizabeth Lule is manager of the World Bank's AIDS campaign team for Africa. In Washington, she spoke to VOA English to Africa Service reporter Joe De Capua.

"We see, I think, some progress, definitely some positive results with HIV prevalence declining in a number of countries, like Kenya, Zimbabwe, Cote d'Ivoire, Mali and Burkina Faso. But we also see a very diverse picture with a hyper-epidemic in southern Africa and very high prevalence rates in South Africa, Swaziland, Lesotho and Botswana and the burden of disease increasing in those countries," she says.

With the HIV/AIDS epidemic more than a quarter of a century old, will it continue indefinitely? Lule says, "Definitely for another generation I would say and depending on whether we make the right investments in the right interventions and address the drivers of the epidemic, which are specific to each country. But we have a large pool of survivors from HIV/AIDS and as you know there is no cure…. With anti-retrovirals we have more people surviving, but who are living with HIV/AIDS. And the new infections, although they have stabilized, the absolute numbers actually continue to grow of people living with HIV/AIDS partly because of population growth in African countries."

The World Bank report says businesses have been hit hard by the disease, claiming the lives of many young, productive workers. It says, "Some private firms in Southern Africa recruit two workers for every job in anticipation of losing staff to the disease." This continues despite anti-retrovirals being able to make HIV/AIDS more of a chronic disease than a death sentence.

Lule says, "It's happening because the coverage of people on anti-retrovirals remains dismally low. Only 30 percent of people who need treatment are actually getting it, partly because of very weak health systems. The fact is that human resources in Africa remain a big problem because of the brain drain, but also HIV/AIDS kills off health workers."

The bank report says that "more than 60 percent of the people living with HIV/AIDS in Africa are women; and that young women are six times more likely to be HIV positive than are young men. As a result of the epidemic, an estimated 11.4 million children under age 18 have lost at least one parent."

Lule says that interventions are needed to protect young women, who are often vulnerable to infection from older men, who may have multiple partners. Poverty also plays a role, often causing many women and girls to become prostitutes to raise money to feed themselves and their families.

The World Bank's "Agenda for Action through 2011" includes: advising countries on the complexities of AIDS fund that's available from such sources as the Global Fund and PEPFAR and building stronger health and financial systems.