UNAIDS: The First 10 Years

UNAIDS The First 10 Years70In 1997, antiretroviral treatment cost around US$ 10 000 – US$ 12 000 per person per year.Under the Drug Access Initiative, the prices came down to about US$ 7200 for a year’s worthof triple therapy. While this reduction in price was not particularly significant, it did startthings moving. Eventually, all companies participating in the initiative offered discountedprices and adhered to the principle of differential pricing for low-income countries.Struggling with the CosponsorsIn late October 1997, the newly appointed UN Secretary-General, Kofi Annan, addressed theCommittee of Cosponsoring Organizations (CCO) of UNAIDS. It was his first meeting withthe group. He spoke of some achievements, then explained: “Much remains to be done.The Joint Programme is still young. It is not easy for organizations that work largely alone inprogramming their resources and budgets to adjust to the requirements of operating a trulyjoint programme”. One might call this an understatement. But he continued: “I expect theUNAIDS experience to show us how to reap the full benefits of a genuinely collective effortwhich will be greater than the sum of its parts. We cannot afford to fail”.Cowal said working with Cosponsors was “like trying to turn round the Queen Mary … I didn’tknow whether the behaviour change to prevent … an AIDS epidemic … or the behaviourchange in the UN system was more difficult. They didn’t like the fact that the creation ofUNAIDS had been primarily donor-driven”. The meetings of the CCO were generally verytense, with hardly any real dialogue among the agencies and often outright hostility towardsthe UNAIDS Secretariat. All this would gradually change for the better over the next fewyears.Piot said that during those early years he felt as though he was moving around with a largeball and chain around his ankle. The donors were constantly asking, “Where are the results?What are you doing?”UNAIDS was expected to produce results on a relatively tight budget and spending on AIDSglobally was very low at this time. In 1996, the annual resources available for AIDS amountedto US$ 292 million and in 1997, US$ 485 million 18 . In the Executive Director’s report to thefourth PCB meeting in March 1997, he wrote that out of a total of US$ 18 million requestedto support Cosponsor activities for the biennium 1996-1997, only US$ 4.8 million had beenreceived or pledged.Eventually, the budget would be fully funded but, as Piot recalled, for some years the PCBset very low budgets for the Secretariat and its country-level staffing.18UNAIDS was expected to raise funds from donors for its staffing and the Cosponsors’ work at global level,though not at country level, where they could raise money themselves. (This added another tension becausedonors were not yet convinced that their new creation would work.)