UNAIDS: The First 10 Years

Chapter 4systems. As the UNAIDS Progress Report 1996–1997(published in 1998) stressed: ‘We cannot yet describethe global response as one of galvanized support forconcerted action on a common set of priorities. Weneed to constantly remind ourselves that we are notsimply observers and analysts of the determinants ofthis epidemic, but actors capable of fundamentallychanging its course. We need to constantly remindourselves that those most affected by the epidemicare also our potential partners; they are best placed toaffect the epidemic’s course’.85Information management was clearly at the core ofmany of UNAIDS’ functions. A major objective of theProgramme was to identify and promote best practicesin responding to the epidemic – whether it be newresearch on drugs, vaccines, microbicides or on effectiveprevention programmes such as peer counselling inschools, using the media for messages on condomsor postponing sexual activity. Following that, the aimwould be to support countries in turning new researchfindings and new policies into programmes.Mother-to-childtransmission remained atough prevention battle forUNAIDS.UNAIDS/L.TaylorIt was harder to reach a consensus with the Cosponsors on some policy issues than others;a prime example was the prevention of mother-to-child transmission of HIV. UNAIDS hadinitiated research in 1996, and there had been several breakthroughs on drug treatment. InFebruary 1998, the Ministry of Public Health in Thailand and the United States Centers forDisease Control and Prevention had conducted a joint trial, which showed that a short courseregimen of Zidovudine was effective in preventing mother-to-child transmission of HIV. InMarch, UNAIDS hosted a meeting on prevention of mother-to-child transmission of HIV at therequest of the United States Agency for International Development (USAID). Paul De Lay, atthat time Head of the HIV Programme of USAID, recalled that by then USAID was using thenew programme for key issues such as the prevention of mother-to-child transmission. DeLay explained: “We had an effective, cheap, realistic intervention and we felt we should justscale this up massively. We needed an honest broker to pull all this together because of all thecontroversies surrounding confidentiality, stigma, discrimination and whether breast feedingshould be recommended when a mother was infected with HIV”.Cowal was asked to run the meeting: “I had no idea that that amount of emotion overbreastfeeding could exist. I was still so naïve. They should have issued me with a bulletproofvest”. It took two days to agree on a statement but, said Cowal, “it was on the lowestcommon denominator … [it said] something like: all women should know their status,should know about the alternative, but that we would never advise anyone”.