UNAIDS: The First 10 Years

Chapter 8CHAPTER 8:Improving the focus on prevention andkey populations, 2004-2005209While the storyof treatment isa dramatic taleof activists, ‘bigbad pharma’,demonstrationsand court cases,prevention is nota ‘sexy’ topic, andhas not receivedthe same mediaattention.Every day, UNAIDS’ staff in Geneva and in country offices were struggling to deal with theurgency and the long-term nature of the epidemic. At the same time as working on advocacyand policy issues, they had to be prepared for troubleshooting – from interruption in theantiretroviral drug supply to the jailing of gay AIDS educators. Every day, a broad range ofissues jostled for their attention. There would always be clear priorities, and ‘making themoney work’ was a major one for this biennium. But there was also a decision to focus moreon policies and programmes that had been sidelined, if not actually neglected – not only byUNAIDS, but by the ‘AIDS industry’ as a whole.Thus, during 2004 and 2005, the UNAIDS Secretariat and Cosponsors highlighted the factthat the focus on treatment had tended to sideline the importance of prevention, as well asovershadow the problem of the growing numbers of infected women.Prevention gains groundSince the announcement about the successful research findings on antiretroviral therapyat the 1996 Vancouver International AIDS Conference, it was inevitable that the spotlightwould be on treatment rather than prevention. While the story of treatment is a dramatictale of activists, ‘big bad pharma’, demonstrations, court cases and, to some extent, a happyending, prevention is not a ‘sexy’ topic, and has not received the same media attention.William Easterly, who was a Senior Research Economist at the World Bank for 16 years 1 , has criticizedthe donors for concentrating on treatment rather than prevention: ‘The rich-country politiciansand aid agencies get more PR [public relations] credit for saving the lives of sick patients,even if the interests of the poor would call for saving them from getting sick in the first place’.Ironically, until recently, the same donors – with the exception of France and Luxemburg –refused to fund antiretroviral therapy and put all their money into HIV prevention.Indeed, although antiretroviral therapy had reduced AIDS-related sickness and death in manycountries, there were still nearly 2.9 million HIV infections estimated in 2004 2 . These infectionscould have been averted had effective prevention programmes been in place. It wasestimated that a comprehensive HIV prevention package could prevent 29 million (or 63%)1Easterly W (2007). The White Man’s Burden: Why the West’s Efforts to Aid the Rest Have Done So Much Illand So Little Good. New York, Penguin Books.2UNAIDS/WHO (2004). AIDS Epidemic Update, 2004. Geneva, UNAIDS.