UNAIDS: The First 10 Years

UNAIDS The First 10 Years74beginning, as the rates of infection among women were increasing annually, especially insub-Saharan Africa, but it would take some years before there was full engagement with theissue – partly as a result of lack of resources in the Secretariat and the Cosponsors.Addressing the challenges of the epidemicIn Western countries, many people believed that the AIDS crisis was over, mainly becauseof the introduction of antiretroviral therapy (popularly mistaken for a cure) and the consequentreduction in mortality. There was little awareness of the growing disaster in lowincomecountries, where few people could afford the simplest medication for opportunisticinfections such as thrush, let alone expensive new drugs. UNAIDS took on the challenge ofcombating such complacency in order to leverage a stronger and better-funded responsefrom the developed world.AIDS wasescalating frombeing a serioushealth crisis intoa full-blowndevelopmentcrisis.Uganda was one of the first countries to show reduced prevalence rates. Former UNAIDSCommunity Mobilization Adviser Noerine Kaleeba recalled how President Yoweri Museveniprovided leadership in Uganda from the mid-1980s 5 . “He had just delivered us Ugandansfrom the era of dictatorship … He made a very smart decision to say, ‘OK, I have just ledyou from one evil, but there’s another evil waiting’. He said at one meeting: ‘Now I’mcalling upon you to rise and challenge AIDS’. He made it politically correct for everyoneto talk on AIDS, because if the President has sent out a call, if you are seen working onthe issue, it is politically correct. There were other countries where if you were seen to beworking on AIDS, you were immediately a subject of suspicion – It was a very, very interestingcontrast that I saw very early”.Some countries provided encouraging examples of good practice in terms of prevention.But most prevention programmes were small scale – they were dubbed ‘boutiques’ – anddid not provide nationwide coverage. The need to ‘scale up’ was a constant theme but thiswas impossible without political action.How to make people act? UNAIDS staff criss-crossed the globe to press politicians,business leaders, and other members of civil society to step up their response. Suchmissions were part of a growing politicization of the epidemic. Activists, people who werepositive, members of nongovernmental organizations; all joined the growing movementto put the epidemic firmly at the top of global priorities. Some leaders were preparedto make hard political choices, risking their popularity. One such example was PresidentErnesto Zedillo of Mexico who, in May 1998, stood firm in the face of criticism of thecountry’s outspoken messages on safer sex and condom promotion. He made it clear thatthe Mexican Government would not give into pressures, particularly from religious authorities,against HIV prevention campaigns.5Interview with Noerine Kaleeba for Frontline: the Age of AIDS, PBS TV, 2007.