UNAIDS: The First 10 Years

Chapter 4CHAPTER 4:Changing the political landscape, 1998-199973UNAIDS/World Health Organization (WHO) estimated that in 1997 there wereapproximately 22 million people living with HIV, and that more than five million people haddied since the beginning of the epidemic. Some 80% of cases were in sub-Saharan Africa,which contains 12% of the world’s population 1 . The annual global expenditure on AIDS in1998 was US$ 479 million. In 1999, global expenditure was US$ 893 million 2 .In retrospect, it is clear that together with the work of activists, UNAIDS’ activities during 1998and 1999, especially in the area of political advocacy, contributed to a change in attitudetowards the epidemic. These activities would in turn lead to significant events and actions atthe start of the twenty-first century that could never have been predicted in 1999.Looking back to this period, UNAIDS Executive Director Peter Piot stressed the importanceof activism: “It is the most potent force to get political leaders to overcome their unwillingnessto act promptly on AIDS … As so often in history, top leadership [is made up of]personal vision and responding to pressure from civil society” 3 .By the end of 1999, more senior leaders – presidents and prime ministers as well as leaders incivil society – were beginning to speak out about the epidemic and showing commitment toaction. In some countries, this was the result of behind-the-scenes diplomacy and hard negotiationsbetween UNAIDS and political leaders in both the South and North. Considerablepatience and persistence were required.At the beginning of 1998, the statistics on the epidemic were much worse than previouslyestimated, especially in sub-Saharan Africa, where AIDS deaths were pushing up mortalityrates, notably among young adults – a pattern otherwise seen only in wartime 4 . At a demographicimpact workshop at the World Bank in January 1998, organized with the UNAIDSSecretariat with the hope of increasing the World Bank’s involvement, several reports hadsuggested that, in some high-prevalence countries, life expectancy at birth had begun todrop back to levels not seen since the 1960s. AIDS was escalating from being a serious healthcrisis into a full-blown development crisis. The public health models created for diseasessuch as smallpox and polio would not be sufficient to contain and reverse this epidemic.Epidemiological surveys and country profiles demonstrated, for example, the need to reduceyoung women’s vulnerability to infection. Gender had been on UNAIDS’ agenda from the1UNAIDS/WHO 2007 AIDS epidemic update, November 2007.2UNAIDS Resource Tracking Consortium, July 2004.3Piot P (2005). Why AIDS is Exceptional. Lecture given at the London School of Economics, London, 8 February.4UNAIDS (1998). Executive Director’s Report to the Sixth Meeting of the UNAIDS PCB, May. Geneva, UNAIDS.