UNAIDS: The First 10 Years

UNAIDS The First 10 Years18in May 1990. He was an experienced UN bureaucrat and during his five years’ tenure heworked hard to increase global funding for AIDS and to improve the management of GPA.However, following Mann’s departure, there was considerable demoralization among thestaff and growing concern among the major donors that GPA was not the most effectiveinstrument or mechanism to combat the epidemic.In 1991, GPA’s income from donors declined for the first time, as did total bilateral andmultilateral contributions for AIDS prevention and care in the developing world 31 .During the later years of GPA, donors and some staff were concerned that WHO/GPA wastaking too medical an approach to the AIDS epidemic. Merson disagreed: “We appreciatedthe importance of involving multiple sectors in the national response. There were peoplewho wanted their agencies to be more prominent in the pandemic and to have more money,and one way to do that was to accuse WHO of being more medicalised”. GPA staff tried hardto take a multisectoral stance but, as part of WHO, they inevitably had to work with ministriesof health that were wary that multisectoralism would take power and money away from them.The concept of multisectoralism was accepted by countries but rarely put into operation;for example, other ministries such as education, interior and justice, defence or finance,were hardly ever involved in AIDS activities and interventions 32 . Two obvious exceptions wereThailand and Uganda; in the early 1990s both had strong multisectoral responses led by theheads of government in Thailand and of state in Uganda, and strongly supported by GPA.Another major criticism of GPA was that it took the ‘one-size-fits-all’ blueprint to countrieswhen developing national AIDS plans. Such a standardized approach did not meet the needfor culturally sensitive plans and programmes. As development experts Tony Barnett andAlan Whiteside have written, GPA was ‘medically and epidemiologically driven and adopteda short-term and conceptually limited fire-fighting perspective based on experience of othermore explosive and shorter-wave infectious disease outbreaks’ 33 . ‘The WHO adopted aseries of “Short- and Medium-Term programmes” in a laudable effort to contain the spreadof the epidemic. These packages were all more or less the same as they were manufacturedand exported from Geneva to the countries of Africa, Asia and Latin America’ 34 . It has alsobeen said that many of the national plans were copies of each other because GPA staff wereoverwhelmed and ‘couldn’t cope with the money coming through the system’ 35 .Another majorcriticism of GPAwas that it tookthe ‘one-sizefits-all’blueprintto countrieswhen developingnational AIDSplans. Such astandardizedapproach did notmeet the need forculturally sensitiveplans andprogrammes.Merson explained that beginning in 1992, GPA did start to work with a number of countriesin preparing their second medium-term plans, which were more country specific.31Jönsson C (1996). ‘From “lead agency” to “integrated programming”: the global response to AIDS in theThird World’, in Helge Ole Bergeson and Georg Parmann (eds), Green Globe Yearbook 1996. Oxford, OxfordUniversity Press.32WHO GPA (1992).33Barnett A, Whiteside A (2002). AIDS in the Twenty-First Century: Disease and Globalization. New York, PalgraveMacmillan.34Ibid.35Interview with former WHO staff member, quoted in Berridge (1996).