The World Bank failed to protect social spending during its structural adjustment operations in the 1980s and 1990s, and this led to the deterioration of basic services - including those needed for the prevention and control of HIV/AIDS. And instead of focusing on HIV/AIDS, the World Bank sought improvements in the way goods and services were provided and financed through health sector reforms, such as user fees, privatisation, decentralisation and integration of services. These reforms frequently had the unintended effect of reducing access to effective health care, including services aimed at the prevention and control of HIV/AIDS. This is according to a paper Produced by ActionAid that evaluates the response to the HIV crisis by the World Bank.