UNAIDS TheThe FirstFirst 1100 YYearsears UNAIDS/07.20E / JC1262E (English original, May 2008) © Joint United Nations Programme on HIV/AIDS (UNAIDS) 2008. All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of UNAIDS concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. UNAIDS does not warrant that the information contained in this publication is complete and correct and shall not be liable for any damages incurred as a result of its use. WHO Library Cataloguing-in-Publication Data Knight, Lindsay. UNAIDS : the fi rst 10 years, 1996-2006 “Initial concept and development: Julia Cleves ; editor: Kath Davies”--Acknowlegements. “UNAIDS/07.20E / JC1262”. 1.UNAIDS - history. 2.Acquired immunodefi ciency syndrome - prevention and control - history. 3.HIV infections - prevention and control - history. I.Cleves, Julia. II.Davies, Kath. III.UNAIDS. IV.Title. ISBN 978 92 9173 589 1 (NLM classifi cation: WC 503.6) UNAIDS 20 AVENUE APPIA CH-1211 GENEVA 27 SWITZERLAND Tel.: (+41) 22 791 36 66 Fax: (+41) 22 791 48 35 e-mail: [email protected] www.unaids.org UNAIDS The First 10 Years 1996–2007 by Lindsay Knight Acknowledgements: Initial concept and development: Julia Cleves Research, additional writing and section on Malawi: Katya Halil Additional research, writing and sections on Côte d’Ivoire, Haiti, Kenya and Ukraine: Froeks Kamminga Photo editor: Sue Steward Assistance with picture research: Manuel Da Quinta Design: Lon Rahn and Nathalie Gouiran Production: Andrea Verwohlt Editor: Kath Davies Proofreading assistance: AvisAnne Julien History Reference Group Internal Reference Group Elhadj As Sy: Director, Partnerships and External Relations, UNAIDS Alistair Craik Richard Burzynski: Executive Director, International Council of AIDS Service Achmat Dangor Organizations Siddharth Dube Rob Moodie: Chair of Global Health, Nossal Institute for Global Health, Elisabeth Manipoud Figueroa University of Melbourne Timothy Martineau Kim Nichols: Co-Executive Director, African Services Committee Elizabeth Parker Peter Piot: Executive Director, UNAIDS Ben Plumley Jeffrey Sturchio: Vice-President, External Affairs, Merck & Co, Inc Keith Wynn Debrework Zewdie: Director, Global HIV/AIDS Programme, World Bank Front page photo UNAIDS/R. Bowman HIV estimates used in UNAIDS the fi rst 10 years The precise numbers of people living with HIV, people who have been newly infected or who have died of AIDS are not known. Achieving 100% certainty about the numbers of people living with HIV globally, for example, would require testing every person in the world for HIV every year—which is logistically impossible and pose ethical problems. But we can estimate those numbers by using other sources of data. The availability and quality of these data have been improving over the ten years covered in this book. For this reason the best estimates of the historic trend in HIV based on current knowledge of the epidemic, have been used for this book. These estimates differ from what was published at the time, but are consistent with current knowledge of the development and of the spread of the HIV epidemic. Contents UNAIDS History: Preface 5 Chapter 1: The beginning of the AIDS epidemic and the United Nations response, 1981–1993 7 Chapter 2: The development and diffi cult birth of UNAIDS, 1994–1995 27 Chapter 3: UNAIDS opens for business, 1996–1997 47 Chapter 4: Changing the political landscape, 1998–1999 73 Country section: Côte d’Ivoire 101 Chapter 5: The end of the beginning: a clear global mandate, 2000–2001 105 Country section: Ukraine 139 Chapter 6: Changing the United Nations landscape in countries, 2002–2003 145 Country section: Haiti 175 Chapter 7: Making the money work, 2004–2005 181 Country section: Kenya – an early proponent of the “Three Ones”” 203 Chapter 8: Improving the focus on prevention and vulnerable groups, 2004–2005 209 Country section: Malawi 231 Chapter 9: Looking to the future: the challenge of sustaining an exceptional response to AIDS 243 The challenges 255 Conclusion 263 Acronyms 264 Index 266 This book is in memory of Julia Cleves; a woman who had vision, humour, prodigious stamina and who was endlessly kind. These attributes and her contribution to international AIDS, health and development work will be remembered by many – and greatly missed by those fortunate to have worked with her. UNAIDS History: Preface This is the history of a relatively young organization – UNAIDS, launched in 1996 to strengthen the way in 5 which the United Nations (UN) was responding to AIDS, one of the worst pandemics the world has ever known. By 1996, some 15 years since a few cases of the new condition were fi rst reported in a scientifi c publication, over four million people had died from AIDS, several million were living with HIV and the future predictions were dire. This book relates the struggles and achievements of the institution, and the contribution it has made to the progress, however slow and faltering at times, in the battle against one of the greatest threats humankind has faced. It also attempts to explain the innovative nature of UNAIDS – a joint programme that has brought together a number of cosponsoring UN organizations (originally six, now 10). Only a special UN programme was deemed capable by its creators of ‘orchestrating a global response to a fast-growing epidemic of a feared and stigmatized disease whose roots and ramifi cations extend into virtually all aspects of society1’. However, due to limitations of space, this is mainly a history of the UNAIDS Secretariat; the readers should not expect a full account of the 10 UNAIDS Cosponsors’ and other partners’ involvement in the fi ght against AIDS. Although, as the book reveals, partnership with individuals and organizations from all sectors of society is, and always has been, key to the work of UNAIDS. So, largely a history of an institution and its staff, the book is structured according to the Programme’s decision-making cycles: its central chapters each span a two-year period because UNAIDS develops its budget and workplan every biennium. Thus, the biennial chapters represent a signifi cant and specifi c period in the life of the organization: every two years, UNAIDS staff, building on the work and lessons of previous years, critically review strategies, initiatives and partners to help contain AIDS. Every two years, UNAIDS staff have a specifi c set of concerns and priorities in their attempt to multiply the number of fronts on which the battle against AIDS is fought. Not only do the chapters represent a specifi c phase in the history of the organization, they also describe paradigm shifts and global progress made in the AIDS response. Each chapter describes the efforts that UNAIDS and its partners were making on many fronts – advocacy, fundraising, prevention, treatment and suchlike, and describes the fruits and failures of UN and global efforts. As such, every chapter weaves in the many different themes and areas of work that together make up the full multisectoral effort and that are at the heart of UNAIDS’ mandate. The themes addressed in this book include access to HIV treatment; advocating politicians to make AIDS a national priority; fi ghting stigma; working with partners to signifi cantly raise the funding for AIDS and supporting countries and donors to use these monies effectively; coordinating the actions of the many AIDS actors; promoting implementation of effective programmes and technical support in countries; and renewing the focus on women’s vulnerability and prevention. At the heart of this history are the stories of many people and their efforts. More than 150 men and women were interviewed; the book is largely based on their accounts. Clearly these are subjective, we do not pretend to have any absolute truths. But we do hope we have provided a multifaceted account of the history of UNAIDS based on multiple subjective views. These most importantly include those of people living with HIV, whose contribution is vital to effective work on AIDS. Although the history plots progress on many levels through the work of UNAIDS and its partners, ultimately it highlights the many challenges the world still faces if this deadly pandemic is to be reversed. 1 Report of the Committee of Cosponsoring Organizations of the Joint and Cosponsored United Nations Programme on HIV/AIDS. E/1995/71,19 May 1995. UNAIDS The First 10 Years 6 UNAIDS/PAHO/ A.Waak Chapter 1 Chapter 1: 7 The beginning of the AIDS epidemic and the United Nations response, 1981–1993 The early days No one could have imagined that a few On 1 January 1996, UNAIDS – the Joint United Nations Programme on HIV/AIDS – cases of rare diseases opened for business. This was 15 years after the fi rst published report of AIDS cases, damaging the immune 15 years during which most of the world’s leaders, in all sectors of society, had displayed system would herald a a staggering indifference to the growing challenge of this new epidemic. pandemic that has killed UNAIDS and the World Health Organization (WHO) estimated in 1996 that more than more than all those who 4.6 million people had died from AIDS since the beginning of the epidemic and that died in battle during the over 20.1 million were then living with the virus that leads to AIDS. The majority of those whole of the twentieth infected (over 15 million) lived in sub-Saharan Africa, followed by more than 31.8 million century. in Asia, 1 million in Latin America and the Caribbean and about 1.5 million in North America and Western and Central Europe1. On 5 June 1981, the United States (US) Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report described some rare pneumonias seen in fi ve gay men and ‘the possibility of a cellular-immune dysfunction related to a common exposure that predisposes individuals to opportunistic infections such as pneumocytosis and candidiasis’.