UNAIDS: The First 10 Years

Chapter 4“I had no ideathat that amountof emotion overbreastfeeding couldexist. I was stillso naïve. Theyshould have issuedme with a bulletproofvest”.to those in the low-income countries. Prevention seemed increasingly the solution, yet as DrCatherine Hankins, now Chief Scientific Adviser at UNAIDS, said: ‘… over 100% more moneyis being spent on therapeutics now than on the development of prevention technologies’ 17 .Also, as Werasit Sittitrai, UNAIDS’ Associate Director, Department of Policy, Strategy andResearch said in the same article (he joined in 1996, having been the Deputy Director ofthe Thai Red Cross Programme on AIDS), ‘we know what prevention works but we don’t doenough of it’. Action on prevention had slowed down, and some programmes had ceasedaltogether.There were many reasons for this, including cultural taboos about discussing sex and sexuality,advocating the use of condoms and so forth. Such taboos existed worldwide. In April 1998in the USA, President Bill Clinton had refused to lift a nine-year ban on using federal fundsfor needle-exchange programmes, despite conclusive evidence that such programmesprevented the spread of HIV. Some years later, at the 16 th International AIDS Conference inToronto, Clinton admitted that this refusal had been a major mistake.87The fi rst Global AIDSReport, 1998UNAIDSThe UNAIDS epidemiology team was constantly refining its working methods in collectingdata and making estimates. UNAIDS presented the conference with the first set of authoritativeHIV surveillance numbers, backed by Harvard University, WHO, the US Census Bureauand others. The numbers showed that over the previous three years, HIV infection rates haddoubled in 27 countries. There were about 4.9 million children made orphans by AIDS in1998, and 92 000 people were becoming infected each day 18 .For the first time, also at the Geneva conference, 180 country-specificepidemiological fact sheets were published, reflecting the diversity ofthe epidemics around the world. Previous estimates had been basedon information from regions; because no data were available fromsome countries, it had been necessary to assume that the pattern ofinfection in those countries would follow that seen in countries in thesame region for which data were available. By 1997, when far moredata were available, it had become clear that there were huge differencesin the development of the epidemic between countries andcommunities in the same region.UNAIDS had been working on methods of improved data analysis sinceearly 1997. A meeting hosted at the Census Bureau in Washington,DC, in 1997, brought together specialists from Latin America, Asia andAfrica to look at the data from the Census Bureau from the surveillancestudies that had been conducted and to come up with the firstcountry-level estimates. In 1998, this group became the UNAIDS17Cate Hankins, quoted in Altman’s article, New York Times, 5 July 1998.18UNAIDS/WHO 2007 AIDS epidemic update, November 2007.