UNITED NATIONS PROGRAMME ON HIV/AIDS
Origins and Background
There is still no cure and no vaccine for AIDS, a generally fatal syndrome that claims the lives of more people worldwide than any other infectious disease. During 1999 the epidemic continued spreading at a rate of 16,000 infections a day, and by year’s end over 33 million people were living with HIV, the virus that causes AIDS--although UNAIDS estimates that nine-tenths of them are unaware of their infection. Because 95% of the epidemic is now concentrated in the developing world, many people with HIV or AIDS have no access to medication, even to relieve their pain and suffering. Over 16 million adults and children have already lost their lives to the disease.
These deaths will not be the last--there is worse to come. Every year AIDS takes new directions: India and South Africa, both relatively untouched only a few years ago, now have among the fastest-growing epidemics in the world. New AIDS epidemics are emerging with frightening speed in Eastern and Central Europe. And sub-Saharan Africa remains the hardest-hit region in the world. Globally, young people--those who must build the bridges, create national wealth and conduct the research of the future--experience half of all new HIV infections. In many parts of the world, AIDS is now the single greatest threat to economic, social and human development.
Through an array of measures including education and services to encourage safer behaviour, some countries such as Thailand and Uganda have managed to turn around what seemed to be unstoppable epidemics. In many countries, however, action is blocked by the conspiracy of shame and silence that surrounds AIDS, even in places where a quarter of the entire adult population is infected. Where people with HIV risk rejection and even persecution, it is not easy for them to access care or take precautions to protect a spouse or child from the virus if doing so might reveal their own infection status. This stigma makes the AIDS challenge special. By the same token, however, people living with HIV have a special role to play in helping society to acknowledge and tackle the epidemic.
From 1986 the World Health Organization (WHO) had the lead responsibility on AIDS in the United Nations, helping countries to set up much-needed national AIDS programmes. But by the mid-1990s, it became clear that the relentless spread of HIV and the epidemic’s devastating impact on all aspects of human lives and on social and economic development were creating an emergency calling for a greatly expanded United Nations effort. Clearly, too, no single UN organization could provide the coordinated assistance needed to address the many factors driving the HIV epidemic, or help countries deal with the impact of HIV/AIDS on households, communities and local economies.
The United Nations, addressing these challenges head-on, took an innovative approach in 1996 by drawing six organizations together in a joint and cosponsored programme: the Joint United Nations Programme on HIV/AIDS. The six original cosponsors of UNAIDS--UNICEF, UNDP, UNFPA, UNESCO, WHO and the World Bank--were joined in April 1999 by UNDCP. Each of them has increased action against AIDS in its own sphere and is actively contributing to the UNAIDS response.
The goal of UNAIDS is to catalyze, strengthen and orchestrate the unique expertise, resources and networks of influence that each of these organizations offers. Working together through UNAIDS, the cosponsors expand their outreach through strategic alliances with other United Nations agencies, national governments, corporations, the media, religious organizations, community-based groups, regional and country networks of people living with HIV/AIDS, and other non-governmental organizations.
With an annual budget of US$60 million and a staff of around 130 professionals, UNAIDS is a modest-sized programme. The UNAIDS secretariat, based in Geneva, operates as a catalyst and coordinator of action on AIDS rather than as a direct funding or implementing agency.
The largest donors to UNAIDS in 1998 were the United States, which contributed US$15 million, followed by the Netherlands, United Kingdom, Sweden, Norway and Denmark. UNAIDS also receives funds from non-traditional donors such as China, Thailand and South Africa.
UNAIDS is guided by a Programme Coordinating Board with representatives of 22 governments from all parts of the world, representatives of the seven UNAIDS cosponsors, and five representatives of non-governmental organizations, including associations of people living with HIV/AIDS. UNAIDS is the first United Nations programme to include NGOs in its governing body.
Through staff based in Geneva and in over 50 countries, the UNAIDS secretariat works with and on behalf of its seven cosponsors in the following major areas.
The secretariat helps spark, coordinate and streamline action by the UNAIDS cosponsors and other UN bodies to bring the epidemic under control. For example, the secretariat brokered joint action with UNICEF, WHO and UNFPA on new strategies for preventing mother-to-child transmission as soon as research showed that brief treatment with antiretroviral pills during pregnancy can help HIV-positive mothers have a healthy baby. At country level, UNAIDS Country Programme Advisers provide support to the cosponsors and host country.
The UNAIDS secretariat plays a key role in the management and dissemination of knowledge that is fundamental to combatting AIDS. It identifies and analyses sound strategies and approaches--what can be called “best practices” for preventing new infections, providing care to those already infected, or alleviating the epidemic’s impact on households, communities and various sectors of society. It helps countries and the UN system establish goals so that they can set clear directions and hold themselves accountable. For example, as part of the five-year follow-up to the International Conference on Population and Development held in Cairo in 1994, UNAIDS advocated the use of HIV infection rates in 15 to 24-year olds as benchmark indicators of progress against the epidemic. This goal was adopted in June 1999 by the UN General Assembly.
The secretariat provides policy guidance, and through technical networks it brokers technical cooperation to help countries implement best practices. In addition, by influencing the global research agenda, the secretariat catalyses the development of new tools and approaches needed by developing countries. One example is the effort to develop an HIV vaccine, a long-term but crucial goal for bringing the epidemic under control.
Tracking the Epidemic
A key function of the UNAIDS secretariat is to gather, analyse and disseminate information on the evolving epidemic and on the global response to it. The resulting picture helps national governments and partners to pinpoint emerging problems and map an appropriate national strategy. Globally, an accurate picture of the epidemic and its disastrous social and economic impact keeps AIDS high on the agenda of development assistance agencies and donor governments.
Both internationally and within countries, UNAIDS advocates for an expanded response to the epidemic. It encourages the use of best practices even when these are sensitive or controversial, such as sexual health education in schools. Most important, the secretariat works to build committed and supportive governments, donors and private companies, and to bring on board a wide range of other partners, NGOs, religious organizations, people living with HIV/AIDS, and those whose lives are otherwise affected or threatened by the epidemic.
Current programme priorities for the secretariat include:
-- working with and for young people to slow HIV transmission and mitigate its impact;
-- programmes focused on highly vulnerable populations;
-- interrupting mother-to-child HIV transmission;
-- integrated prevention and care approaches, including the development of community-based standards of AIDS care;
-- vaccine development; and
-- special initiatives for hard-hit regions, including sub-Saharan Africa.
UNAIDS at Country Level
In developing countries UNAIDS operates mainly through the country-based staff of its seven cosponsors, which coordinate their efforts through a United Nations Theme Group on HIV/AIDS. At meetings of the theme group, representatives of the cosponsoring organizations share information, plan and monitor coordinated action between themselves and with other partners, and decide on joint financing of major AIDS activities in support of the country’s partners--governmental and non-governmental. The principal objective of the theme group is to support the host country’s efforts to mount a strategic and comprehensive response to HIV/AIDS.
In priority countries the theme group has the support of a UNAIDS staff member, called a Country Programme Adviser (CPA). Elsewhere, a staff member of one of the seven cosponsors serves as the UNAIDS focal point for the country. These staff have the triple task of supporting the UN system, building national commitment to AIDS action, and providing information and guidance to a range of host country partners, including government departments and groups and organizations from civil society, such as people living with HIV/AIDS.
The UNAIDS secretariat makes catalytic funding available for selected AIDS initiatives in developing countries and countries with economies in transition. Between January 1998 and May 1999, proposals were received and approved for projects in a total of 87 countries.
As of April 1999, the UNAIDS cosponsors had established 132 United Nations Theme Groups on HIV/AIDS covering 155 countries. For their day-to-day operations, most theme groups have set up special working groups that involve donors, NGOs and groups of people living with HIV/AIDS.
During 1998-1999, consultations between the UNAIDS secretariat and NGOs--in particular the United Kingdom Consortium on AIDS--resulted in a UNAIDS Position Paper on Collaboration with NGOs. Through an electronic mailing list, the secretariat keeps NGOs informed of new developments and important information that they can pass on to their own constituencies and networks around the world.
The secretariat also continues to provide direct technical assistance to NGOs. For example, in Latin America the first regional consultation of HIV-positive women, organized with UNAIDS support, enabled them to become linked to one another through a functioning network, as well as to the International Community of Women with AIDS (ICW). While the UNAIDS secretariat is phasing out its support of core costs for ICW, the Global Network of People Living with HIV/AIDS (GNP+) and the International Council of AIDS Service Organizations (ICASO), other forms of collaboration with these three global networks have intensified. Thus, the secretariat provides technical support to the Asia-Pacific Council of AIDS Service Organizations for its regional activities, the African Council of AIDS Service Organizations for developing its workplan, and to GNP+ for a biennial international conference for people living with HIV/AIDS, which it convenes jointly with ICW. Together with UNDP, a UNAIDS cosponsor, the secretariat is supporting capacity building of the African Network of People with AIDS.
The secretariat also promotes the involvement of global and regional NGOs that do not yet work on AIDS but have the potential interest and ability to do so. For example, ICASO was brought together with the World Association of Girl Guides and Girl Scouts (WAGGGS) to help the latter draw up its new AIDS programme. In collaboration with Caritas Internationalis, Catholic youth organizations in Africa were identified that could work on advocacy, prevention and care with the UN system. With UNDP, the secretariat assisted the Salvation Army to prepare for the first meeting on AIDS between church-based development NGOs, held in Botswana in 1999. Ongoing collaboration with AIDES Fédération France on capacity building for NGOs in care and support in West Africa will form part of the Africa Partnership being formed by UNAIDS and its partners, including NGOs.
Calle Almedal, Senior NGO Liaison Officer, UNAIDS, 20 avenue Appia, CH-1211 Geneva 27, Switzerland, telephone +41-22/791 4570, fax +41-22/791 4188, e-mail <firstname.lastname@example.org> or UNAIDS Information Centre, 20 avenue Appia, CH-1211 Geneva 27, Switzerland, telephone +41-22/791 4651, fax +41-22/791 4165 or 791 4741, e-mail <email@example.com>, website (www.unaids.org).