UNAIDS: The First 10 Years

Chapter 8“Prevention ischallenging becauseyou have to dealwith social normsand behaviours”.Thus, UNAIDS began developing a strategy in order to place prevention ‘more centrally onthe global AIDS agenda’ 5 . ‘Prevention for all’ was a major policy issue for UNAIDS during the2004–2005 biennium.The challenges to expanding prevention211The subject of HIV prevention is controversial and disturbing. In most societies, there isstrong cultural resistance to discussing sexuality, especially sex between men and commercialsex, and the use of drugs. Social conventions and taboos get in the way of saving lives.In countries where sex work and injecting drug use are illegal, it is not easy to provideprevention programmes for these key populations. This reluctance has not been confinedto countries in the developing world. In Margaret Thatcher’s United Kingdom, the firstNational Survey of Sexual Attitudes and Lifestyles (Natssal 1990), a major research projectinto people’s sexual behaviour, was denied public funding, and was funded independentlyinstead 6 . The Roman Catholic Church still does not condone the use of condoms, althoughin 2007 the Vatican was considering moves towards a revised policy.Prevention efforts are severely hampered by stigma. Stigma and discrimination againstpeople living with HIV and gender inequality were, experts agreed, the two biggest challengesto HIV prevention in South Asia and Africa. Noerine Kaleeba, founder of The AIDSSupport Organisation in Uganda and formerly Partnerships and Community MobilizationAdviser at UNAIDS, said: “Even in Uganda, though we’ve come a long way, there’s still very,very subtle stigma that continues to hinder people from accessing care”.Thoraya Obaid, Executive Director of the United Nations Population Fund, commented:“I think the issue of prevention sometimes falls off the table because it is much easierto emphasize treatment: treatment is concrete, whereas prevention is harder to measure... Prevention is challenging because you have to deal with social norms and behaviours”.There had been relatively little information on how treatment affected prevention in developingcountries, but research done in 2004 using epidemiological modelling suggestedthat treatment makes prevention more effective and prevention makes treatment moreaffordable 7 . There is also increasing evidence from many locations that the push to expandtreatment has led to an expansion of testing and counselling. In one district in Uganda,the introduction of antiretroviral therapy led to a 27-fold increase in numbers of peopleseeking testing and counselling. When the Global Fund’s first substantial grant to Haitiscaled up treatment for people living with HIV, tens of thousands sought testing and coun-5UNAIDS (2004). Executive Director’s Report to the 16th Meeting of the UNAIDS PCB, December. Geneva,UNAIDS.6Results from the first Natssal were published in the book Sexual Attitudes and Lifestyles by A Johnson,J Wadsworth, K Wellings and J Field (Blackwell, Oxford, 1994).7Salomon J A, Hogan D R, Stover J, Stanecki K A, Walker N, Ghys P D, Schwartländer B (2005). ‘Integrating HIVprevention and treatment: from slogans to impact.’ PLoS Medicine, 2, (1, e16) January.