UNAIDS: The First 10 Years

UNAIDS The First 10 Years24not a strong tradition of collaboration. … [Another problem] was the fact that GPA wasnever financed through WHO’s regular core budget. It could have continued as a WHOprogramme otherwise. GPA did a wonderful job, let’s not forget that”.There is also a view that donors wanted to cut back on, and have more control over, theirfunding on AIDS to abandon the large Programme they had helped to build – that is,GPA. Certainly some hoped that the new Programme might pave the way for UN reform– a cheaper, more flexible body, more rooted at country level and more accountable todonors.Interagency rivalries and the behaviour of some WHO staff undoubtedly provided ammunitionto those supporting the demise of GPA. Rob Moodie, who had been a consultantto GPA (and the first Director of Country Support at UNAIDS) recalled that after Mannleft, WHO’s approach was, “let’s keep AIDS in the health sector” and “let’s ignore theother UN agencies”. Former UNICEF staff such as Deputy Executive Director RichardJolly said that in the 1980s WHO resented UNICEF’s work on AIDS education and socialmobilization; “they were saying, ‘Hands off’ our territory”. Yet in September 1990, whenthere was a World Summit on Children to set goals for children’s health by the year 2000,Merson really pushed for a goal on children and AIDS, and UNICEF Executive DirectorJim Grant categorically refused to include any mention of AIDS in the targets.Nabarro noted that interagency rivalries and disagreements refl ected “a fairly majortension on the ground” that he had experienced when working in Uganda in the 1980s.“It was very interesting”, said Nabarro, “to see then, in the mid- to late-80s, and to recallnow 20 years later, how profound was the ideological split. Some agencies said, ‘we mustdeal with HIV/AIDS as a communicable disease. The control of everything, including howto communicate about HIV to societies and how to handle the resources, should be withpeople who have qualifications in public health and epidemiology, and the ministry ofhealth’. Others said, ‘HIV and AIDS are societal issues; responses have to take account ofcultural context, sexual practice, reality and denial, the status of women and educationof girls’. Even then, in the mid- to late-80s, we saw the elements of discord about thehandling of HIV that has lasted for 10 to 15 years”.Jolly is very clear about UNICEF’s attitude towards the new Programme. “The UNICEFposition was positive towards collaboration … [but] negative or at the very least extremelycautious [about] coordination … but we did recognize the need to work together.”Discord between the UN agencies – and between some of the donors – would certainlycomplicate the establishment of UNAIDS during 1994 and 1995, and its operating capacityfor several years thereafter. Yet the AIDS pandemic was spreading and the numbers ofcases rising. UNAIDS/WHO would later estimate that in 1993 there were about three