UNAIDS: The First 10 Years

UNAIDS The First 10 Years38stand either what UNAIDS was or what it intended to be. All the negotiating had taken placeat HQs [Headquarters] and the outcomes were not well communicated to country offices.We were also very aware of how badly the UN agencies worked together. It took time forUNAIDS to learn to communicate its own mission”.Clement Chan-Kam joined the preparatory team in mid-1995 from GPA where he had workedfor four years after managing the National AIDS Programme in Mauritius. He went on severalregional visits: “I remember trying to reassure people, in WHO as well as national programmestaff, that far from UNAIDS being a death sentence for WHO’s AIDS Programme and far frombeing a kind of crisis situation for countries in terms of fund flows and technical support, itwould actually mean their being able to call upon the collective resources and know-how ofsix Cosponsors rather than just WHO. Looking back, I feel we must have been very naïve, butwe all truly believed in that because that was what UNAIDS was meant to be”.From the beginning, a significant difference between GPA and UNAIDS at country levelcreated difficulties. GPA had funded national AIDS programmes through ministries of health.UNAIDS, however, was intended to coordinate and facilitate funding rather than provide itdirectly, but such nuancing meant little to those countries that suddenly had no money forAIDS programmes.In marking out the difference between GPA and UNAIDS, Piot was always concerned with theimportance of country ‘ownership’, that is, whether countries would feel they were makingthe crucial decisions in planning their response to the epidemic rather than ‘outsiders’ suchas the UN in Geneva. “While working at GPA, I didn’t see anywhere the ownership in thedeveloping countries. I had worked enough in Africa to know that if people don’t feel ‘It’s myproblem’ then they won’t really move”.Working with cosponsoring agenciesThe UNAIDS preparatory team was housed in a building next to the main WHO headquartersalongside what remained of the GPA staff. As Mane explained, initially there was a lot ofanger about UNAIDS and a reluctance to cooperate. “I completely understood – I had lotsof colleagues [in GPA] who lost jobs … people felt threatened. At the same time, there weremany people who really cared about the response to the disease who … I must admit, wentbeyond institutional differences and said, ‘You know, we’ve got to make this succeed. This isreally too important’”.WHO was responsible for the administrative support of UNAIDS. Bertozzi speculated on whetherit might have been better to make a ‘clean break’ from WHO because: “We spent an enormousamount of our energy fighting with the Nakajima administration to get the kind of support weneeded, everything from hiring people, travel policy and suchlike. It was very demoralizing”.