UNAIDS: The First 10 Years

UNAIDS The First 10 Years220A 10 th Cosponsor joins the programmeIn June 2004, the Office of the United Nations High Commissioner for Refugees (UNHCR)joined UNAIDS as its 10 th Cosponsor. In its work with refugees and others (for example, internallydisplaced person and asylum seekers), UNHCR is at the forefront of combating HIV among aparticularly vulnerable group of people. The very fact that UNHCR became a UNAIDS Cosponsormade a strong statement to the international community. The agency was better able to advocate forthe provision of HIV services to displaced populations. Paul Spiegel, the Head of UNHCR’s HIVUnit, explained: “In all major global documents on AIDS, there is now at least a mention of conflictaffectedor displaced persons where there wasn’t before. So [joining UNAIDS] has been a hugeadvocacy tool because it’s brought us to the table and allowed us to advocate and say, ‘Hey, let’s notforget about these marginalised and vulnerable groups’”.It was only in 2002 that UNHCR decided to strengthen its work on AIDS, with the support ofthe Centers for Disease Control and Prevention (CDC), a United States (US) Government agency,by setting up its HIV Unit. Spiegel, a physician and medical epidemiologist who had worked for15 years in complex humanitarian emergencies, was chosen to head the new Unit.AIDS became a policy priority within UNHCR, and the agency has now conducted over40 assessment and evaluation missions in 17 countries, which resulted in significant additionalfunding to improve their HIV programmes. Staff in the UNHCR AIDS unit increased from one toeight, with five of the eight new staff members working as field-based regional HIV coordinators.The agency has prioritized the integration of refugees in the host country’s HIV programmes. Insome cases, refugees have remained uprooted from their home communities for up to 20 years, withonly limited access to their host countries’ medical or HIV services. UNHCR’s actions and policiesare based on the view that refugees deserve medical services equal to those of the surroundingcommunities, and that reaching these individuals, in an integrated and coordinated approach withtheir surrounding host countries, is a vital approach for ensuring HIV prevention, care, support andtreatment.“The concept that we’re really pushing is for an integration of services between refugees andsurrounding populations, in particular as antiretroviral therapy expands. We should not be providingparallel systems for service delivery to host populations and to refugees”, explained Spiegel. Fromthis perspective, respecting basic human rights principles and implementing an effective public healthstrategy strongly coincide.Refugees are often accused of spreading HIV in their host countries. In 2004, UNHCR publishedimportant new findings, suggesting that refugees in five out of seven countries had significantlylower HV prevalence than the surrounding communities (refugees had similar prevalence to thesurrounding host communities in the other two countries). The same study had also, for the firsttime, examined attitudes and behavioural trends among displaced populations. It revealed thatrefugees in camps in Africa ‘have made “dramatic strides” in changing their behaviour to reduce therisks of contracting and spreading HIV’ 16 .16UNHCR (2004). News Stories, 7 June. Nairobi, UNHCR.