UNAIDS: The First 10 Years

Chapter 5major donor in the early years of the epidemic. But, in September, the European Commissionhad convened a high-level Round Table meeting on communicable diseases and povertyreduction, chaired by Romano Prodi, President of the Commission, and cosponsored by theUNAIDS Secretariat and WHO. At the Round Table it was decided to focus on AIDS, tuberculosisand malaria. A first step was to design a new plan of action to tackle these diseases.117“The World Banktalking about ithelped make AIDSa mainstreamdevelopment topic”.On 8 September, at the UN Millennium Summit that led to the UN Millennium Declaration,158 heads of state and government from countries heavily affected and others less so,referred to the fight against AIDS. Several used their precious five minutes to speak exclusivelyabout AIDS. Many referred to AIDS as one of the greatest challenges in the twenty-firstcentury. The UN Secretary-General’s report had a major section on promotion of health andcombating AIDS.The World Bank takes action: the Multi-Country HIV/AIDS Programme for AfricaAction was needed, not just words – as well as significant funding. Although certain WorldBank staff had been very involved with, and supportive of, UNAIDS right from the outset, theBank’s response in terms of funding had been disappointing to many of its staff as well asthose outside. This was partly because of the lack of firm leadership on the issue but also, infairness, because countries were not themselves proposing projects on HIV/AIDS for loans– a further sign of leaders’ denial.Not everyone at the Bank’s head office was convinced of the pandemic’s importance 10 .Although the Bank’s World Development Report in 1993 acknowledged that by 2000, AIDSmight be killing 1.6 million people every year, it also noted that tobacco might kill two millionannually (which, of course, was true).As Keith Hansen, now Sector Manager of Health, Nutrition & Population for Latin Americaand the Caribbean at the World Bank, explained: “As late as the mid-1990s, the Bank wasnowhere near to bringing the full brunt of its resources and influence to bear on the epidemic… It was really only in the late 1990s that … the Bank became engaged at an institutionallevel”. As the Bank’s lending for HIV/AIDS fell (from US$ 67 million in 1994) to US$ 41.7million in 1997, Debrework Zewdie cautioned in 1998 that the progress of the last 20 to 30years ‘on the development front in Africa is now in jeopardy’ 11 .The year 1999 brought change at the Bank, partly because of the advocacy of two Bankofficials, Zewdie and Hans Binswanger (the latter made it known at a meeting that he himselfwas positive), mainly because of the increasingly disturbing data coming from UNAIDS and its10Mallaby S (2004). The World’s Banker. New York, Penguin Books.11Behrman (2004).