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UNAIDS: Trying to Gain Traction

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The AIDS Pandemic

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Abstract

This chapter describes the evolution of the Joint United Nations Programme on HIV/AIDS (UNAIDS). At a time when the discovery of Highly Active Antiretroviral Therapy (HAART) had energized the AIDS community, UNAIDS faced significant difficulty trying to establish its leadership amongst shrinking budgets, quarrelling cosponsors, inconsistent and inadequate support from donors, and a strained relationship with the World Health Organization. UNAIDS established UN theme groups on HIV/AIDS to provide a single UN voice on AIDS policies in countries, strove to improve access to HAART, especially in low- and middle-income countries, and built relationships with nontraditional partners, particularly non-governmental organizations, faith-based organizations, and the business community. Against this back drop, the AIDS world lost one of its greatest champions when Jonathan Mann tragically died in a commercial plane crash.

Within this chapter the singular pronouns I and my refer to Michael Merson alone, whereas the plural pronouns we and us generally refer to Michael Merson and Stephen Inrig jointly. Where we or us refers to Michael Merson and his colleagues at WHO, the object of the pronoun is clarified by context.

The original version of this chapter was revised to correct misspellings.

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Notes

  1. 1.

    Lawrence K. Altman, “ Exuberant Mood of AIDS Meeting Reflects Progress,” Contra Costa Times, Sunday, July 7, 1996, D01.

  2. 2.

    For the purposes of this text, we will use the term AIDS to encompass both AIDS and HIV unless otherwise specified.

  3. 3.

    David Perlman, “A Bit Less Gloom in AIDS Battle—Optimistic backdrop to world conference,” The San Francisco Chronicle—Friday, July 5, 1996, A1.

  4. 4.

    Lawrence K. Altman, “Exuberant Mood of AIDS Meeting Reflects Progress,” Contra Costa Times, Sunday July 7, 1996, D01.

  5. 5.

    David Perlman, “A Bit Less Gloom in AIDS Battle—Optimistic backdrop to world conference,” The San Francisco Chronicle—Friday, July 5, 1996, A1.

  6. 6.

    Ibid.

  7. 7.

    Ibid.

  8. 8.

    Ibid.

  9. 9.

    Lawrence K. Altman, “Exuberant Mood of AIDS Meeting Reflects Progress,” Contra Costa Times, Sunday, July 7, 1996, D01.

  10. 10.

    Newsweek, around that time, had a cover entitled, “The End of AIDS.”

  11. 11.

    “HIV/AIDS: USAID and UN Response to the Epidemic in the Developing World; Report to Congressional Requesters, July 1998,” Washington, DC: General Accounting Office, 1998, GAO/NSIAD-98-202.

  12. 12.

    Lindsay Knight. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008.

  13. 13.

    US Census Bureau, “HIV/AIDS Surveillance.” Washington, DC: US Department of Commerce. Cited at http://www.census.gov/population/international/about/; accessed May 22, 2012.

  14. 14.

    Lindsay Knight. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008, 63.

  15. 15.

    Sue Funnell, “An Evaluation of the UNAIDS Best Practices Collection,” Geneva: UNAIDS, November 1999, 1.

  16. 16.

    Sally Cowal, Interview by Michael Merson, New Haven, CT, February, 2002.

  17. 17.

    Lindsay Knight. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008, 64; “Learning from Experience,” Geneva: Joint United Nations Programme on HIV/AIDS, January 19, 2007, http://www.unaids.org/en/resources/presscentre/featurestories/2007/january/20070119bestpracticehistory/. Accessed on May 22, 2012.

  18. 18.

    Lindsay Knight. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008, 64.

  19. 19.

    Werasit Sittitrai, “HIV Prevention Needs and Successes: A Tale of Three Countries,” Geneva: UNAIDS, 2001, 9–14.

  20. 20.

    Ibid, 5–19.

  21. 21.

    Peter Piot, No Time to Lose: A Life in Pursuit of Deadly Viruses. New York: Norton, 2012.

  22. 22.

    Centers for Disease Control and Prevention. “Zidovudine for the prevention of HIV transmission from mother to infant,” MMWR, 1994 Apr 29;43(16):285–7; P.Cotton, “Trial halted after drug cuts maternal HIV transmission rate by two thirds.” JAMA. 1994 Mar 16;271(11):807. J. Oleske, A. Bardequez, “Research shows AZT therapy reduces mother-child AIDS transmission.” New Jersey Medicine, 1994 Apr;91(4):274; CDC. “Recommendations of the U.S. Public Health Service Task Force on the Use of Zidovudine to Reduce Perinatal Transmission of Human Immunodeficiency Virus.” MMWR, August 05, 1994;43 (No. RR-11); 1–20; C. Peckham. “Mother to child transmission of the human immunodeficiency virus.” New England Journal of Medicine 1995;333:298–302; “Zidovudine for the prevention of HIV transmission from mother to infant.” MMWR 1994;43:285–7; Edward M. Connor, Rhoda S. Sperling, Richard Gelber et al. “Reduction of maternal-infant transmission of human immunodeficiency virus-type 1 with zidovudine treatment.” New England Journal of Medicine 1994;331:1173–80; M. Rogers and Harold Jaffe. “Reducing the risk of maternal-infant transmission of HIV: a door is opened.” New England Journal of Medicine 1994;331:1222–3.

  23. 23.

    Jon Cohen. “Bringing AZT to poor countries.” Science 269.5224 (1995): 624–6; “Ethics of Placebo-Controlled Trials of Zidovudine to Prevent the Perinatal Transmission of HIV in the Third World,” New England Journal of Medicine 1998; 338:836–841.

  24. 24.

    Arjan de Wagt, David Clark, “UNICEF’s Support to Free Infant Formula for Infants of HIV Infected Mothers in Africa: A Review of UNICEF Experience,” Linkages, April 14, 2004.

  25. 25.

    Lindsay Knight. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008.

  26. 26.

    Arjan de Wagt, David Clark, “UNICEF’s Support to Free Infant Formula for Infants of HIV Infected Mothers in Africa: A Review of UNICEF Experience,” Linkages, April 14, 2004.

  27. 27.

    UNAIDS (2002). Five Year Evaluation of UNAIDS . Geneva, UNAIDS, cited in Lindsay Knight. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008.

  28. 28.

    Lindsay Knight. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008.

  29. 29.

    Sally Cowal, Interview by Michael Merson, New Haven, CT, February, 2002.

  30. 30.

    ”Paris Declaration,” Paris AIDS Summit - 1 December 1994, European Coalition of Positive People; http://www.ecpp.co.uk/parisdeclaration.htm

  31. 31.

    Lindsay Knight. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008.

  32. 32.

    Ibid.

  33. 33.

    Ibid.

  34. 34.

    Ibid.

  35. 35.

    Hung Fan, Ross Conner, Luis Villarreal, AIDS: Science and Society, 4th ed., Sudbury, MA: Jones and Bartlett Publishers, 2004. p. 62.

  36. 36.

    Lawrence K. Altman, “3-Drug Therapy Shows Promise Against AIDS,” The New York Times, January 30, 1996, C5.

  37. 37.

    Lauran Neergaard, “FDA: New AIDS Drugs Are Promising,” The Charlotte Observer, November 5, 1995, 2A; Lauran Neergaard, “FDA Panel Oks New AIDS Drug,” The Charlotte Observer, November 8, 1995; John Schwartz, “FDA Panel Oks New AIDS Drug,” The Charlotte Observer, November 8, 1995, 1A; Lauran Neergaard, “FDA Oks Drugs That Retard AIDS Virus,” The Charlotte Observer, December 8, 1995, 10A; Lawrence K. Altman, “3-Drug Therapy Shows Promise Against AIDS,” The New York Times, January 30, 1996, C5; Daniel Q. Haney, “AIDS Therapy With 3 Drugs Appears To Stall Disease,” The Charlotte Observer, January 30, 1996, 4A.

  38. 38.

    David Perlman, “Worry, Hope At AIDS Conference: Breakthroughs have too high a price for many,” San Francisco Chronicle, July 8, 1996, A1.

  39. 39.

    Ibid.

  40. 40.

    Francisco Inácio Bastos, Deanna Kerrigan, Monica Malta, Claudia Carneiro-da-Cunha, and Steffanie A. Strathdee, “Treatment for HIV/AIDS in Brazil: strengths, challenges, and opportunities for operations research,” AIDScience Vol. 1, No. 15, November 2001, accessed at http://aidscience.org/Articles/aidscience012.asp

  41. 41.

    Marcus Low, Catherine Tomlinson, Mara Kardas-Nelson, Kay Kim and Nathan Geffen, Fighting for our lives: The history of the Treatment Action Campaign, 1998–2010. Cape Town, SA: Treatment Action Campaign, 2010, 3.

  42. 42.

    Lindsay Knight. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008, 68.

  43. 43.

    Access to drugs: UNAIDS Technical Update. Geneva: UNIADS, October 1998, WC 503.2, 11.

  44. 44.

    Gaston Djomand, Thierry Roels, Terence Chorba, “HIV/AIDS Drug Access Initiative: Preliminary Report,” Projet RETRO-CI, May 2000. http://pdf.usaid.gov/pdf_docs/Pnacl667.pdf, accessed on May 24, 2012; B. Schwartländer, I. Grubb, J. Perriëns. “The 10-year struggle to provide antiretroviral treatment to people with HIV in developing countries.” The Lancet , 2007, 368():541–546.

  45. 45.

    B. Schwartländer, I. Grubb, J. Perriëns. “The 10-year struggle to provide antiretroviral treatment to people with HIV in developing countries.” The Lancet , 2007, 368:541–546.

  46. 46.

    Joseph Perriens, Interview by Michael Merson, Geneva, September, 2001.

  47. 47.

    B. Schwartländer, I. Grubb, J. Perriëns. “The 10-year struggle to provide antiretroviral treatment to people with HIV in developing countries.” The Lancet , 2007, 368:541–546.

  48. 48.

    Peter Piot No Time to Lose: A Life in Pursuit of Deadly Viruses. New York: Norton, 2012, 303–310.

  49. 49.

    Lindsay Knight UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008.

  50. 50.

    Ibid.

  51. 51.

    Ibid, 86.

  52. 52.

    Ibid, 87.

  53. 53.

    Ibid.

  54. 54.

    Michael Balter, “Global Program Struggles to Stem the Flood of New Cases,” Science, June 19 1998, 280(5371):1863–1864.

  55. 55.

    Lindsay Knight. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008.

  56. 56.

    Michael Balter, “Global Program Struggles to Stem the Flood of New Cases,” Science, June 19 1998, 280(5371):1863–1864.

  57. 57.

    Lindsay Knight. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008.

  58. 58.

    Peter Piot, Interview by Stephen Inrig, Dallas, TX, February 2, 2011; “Proposed Programme Budget, 1996–1997.” Geneva: Joint United Nations Programme on HIV/AIDS, October 1995.

  59. 59.

    Stefano Bertozzi, Interview by Michael Merson, New Haven, NC, December, 2002.

  60. 60.

    Ibid.

  61. 61.

    Jeff O’Malley, Interview by Michael Merson, New Haven, CT, September, 2002.

  62. 62.

    Lars Kallings, Interview by Michael Merson, New Haven, CT, September, 2002.

  63. 63.

    Lindsay Knight. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008.

  64. 64.

    Michael Balter, “Global Program Struggles to Stem the Flood of New Cases,” Science, June 19 1998, 280(5371):1863–1864.

  65. 65.

    Peter Piot, Interview by Stephen Inrig, Dallas, TX, February 2, 2011.

  66. 66.

    Ibid.

  67. 67.

    Stafano Bertozzi, Interview by Stephen Inrig, October 22, 2010.

  68. 68.

    Ken Bernard, Interview by Michael Merson, New Haven, CT, February, 2002.

  69. 69.

    Ibid.

  70. 70.

    Hu Ching Li, Interview by Michael Merson, New Jersey, August, 2002.

  71. 71.

    William Muraskin, The Politics of International Health: The Children’s Vaccine Initiative and the Struggle to Develop Vaccines for the Third World (Albany: State University of New York Press, 1998), cited in Theodore M. Brown, Marcos Cueto, and Elizabeth Fee, “The World Health Organization and the Transition From ‘International’ To ‘Global’ Public Health,” Am J Public Health. 2006;96:62–72.; William Muraskin, “Origins of the Children’s Vaccine Initiative: The intellectual foundations,” Social Science & Medicine June 1996, 42(12): 1703–1719.

  72. 72.

    See, for example, Dorothy Blake, “Signed Letter of Agreement between WHO and UNAIDS,” Geneva: World Health Organization, May 13, 1996, JW/cch/A21/372/2.

  73. 73.

    George Alleyne, Interview by Michael Merson, New Haven, CT, August, 2002.

  74. 74.

    Jo Asvall, Interview by Michael Merson, January, 2002.

  75. 75.

    S.T. Han, Interview by Michael Merson, New Haven, CT, August 30, 2012.

  76. 76.

    Hu Ching Li, Interview by Michael Merson, New Jersey, August, 2002.

  77. 77.

    For the purposes of this text, we use the term sexually transmitted disease(s) and the abbreviation STD rather than the other term sexually transmitted infection(s) or STIs.

  78. 78.

    “First Planning Meeting on HIV/AIDS and STD, Geneva, 7–9 May, 1996: Regional Programme Statement for 1998–1999 programme budget,” Geneva: World Health Organization, 1996, 4/6, 2; HIV/AIDS and Sexually Transmitted Diseases: WHO Policy and Strategic Orientations,” Geneva: World Health Organization, May 1996, Rv. 12, 5.

  79. 79.

    Neil Boyer, Interview by Michael Merson, New Haven, CT, January, 2002.

  80. 80.

    Stefano Bertozzi, Interview by Michael Merson, New Haven, NC, December, 2002.

  81. 81.

    Dorothy Blake, “WHO’s Comments on UNAIDS Workplan; Memorandum to P. Piot,” Geneva: World Health Organization, June 7 1996, As2-372-2.

  82. 82.

    Ken Bernard, Interview by Michael Merson, New Haven, CT, February, 2002.

  83. 83.

    Claire Chollat-Traquet, Interview by Michael Merson, New Haven, CT, August 12, 2002.

  84. 84.

    Gunilla Ernberg, Interview by Michael Merson, New Haven, CT, August, 2002.

  85. 85.

    Stefano Bertozzi, Interview by Michael Merson, New Haven, NC, December, 2002.

  86. 86.

    Ibid.

  87. 87.

    Peter Piot No Time to Lose: A Life in Pursuit of Deadly Viruses. New York: Norton, 2012, 226–227.

  88. 88.

    Lindsay Knight. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008.

  89. 89.

    Eleanor Gouw, “EPI Alert: Methods for estimating HIV incidence” UNAIDS Quarterly Update on HIV Epidemiology Geneva: UNAIDS, 1Q, 2010. http://www.unaids.org/sites/default/files/media_asset/epi_alert_1stqtr2010_en_0.pdf

  90. 90.

    Stefano Bertozzi, Interview by Michael Merson, New Haven, NC, December, 2002.

  91. 91.

    Christopher Wilson, “Finding the Middle Ground in a Spectrum of Collaboration,” Presentation at the Knowledge Exchange Forum, 2010, Ottawa, ON, Canada, November 24, 2010. www.slideshare.net/cwilson_ottawa/phac-knowledge-exchange-forum-nov-2010. Accessed March 4, 2013.

  92. 92.

    Ken Bernard, Interview by Michael Merson, New Haven, CT, February, 2002.

  93. 93.

    Mina Mauerstein-Bail, Interview by Michael Merson, New Haven, CT, September, 2002.

  94. 94.

    Mina Mauerstein-Bail, Interview by Michael Merson, New Haven, CT, October, 2001.

  95. 95.

    Ibid.

  96. 96.

    Ibid.

  97. 97.

    Jeff O’Malley, Interview by Michael Merson, New Haven, CT, September, 2002.

  98. 98.

    The UNDP HIV and Development Program continued its own independent way of operations. It would continue in this fashion until early 1998.

  99. 99.

    See, for example, Peter Piot, “Letter to Elizabeth Reid: US State Department Request, March 28, 1995.” Geneva: Joint United Nations Programme on AIDS, 1995, GPA-A20/372/30.

  100. 100.

    Stefano Bertozzi, Interview by Michael Merson, New Haven, NC, December, 2002.

  101. 101.

    Gillian Holmes, Interview by Michael Merson, Geneva, October, 2001; Nils Kastberg, Interview by Michael Merson, New York City, September, 2002.

  102. 102.

    Marjory Dam, Interview by Michael Merson, New Haven, CT, September 29, 2001.

  103. 103.

    Helene Gayle, Interview by Michael Merson, New Haven, CT, February, 2002; Nils Kastberg, Interview by Michael Merson, New York City, September, 2002.

  104. 104.

    Stefano Bertozzi, Interview by Michael Merson, New Haven, NC, December, 2002.

  105. 105.

    “HIV/AIDS: USAID and UN Response to the Epidemic in the Developing World; Report to Congressional Requesters, July 1998,” Washington, DC: General Accounting Office, 1998, GAO/NSIAD-98-202.

  106. 106.

    Lindsay Knight. UNAIDS: the first 10 years, 1996–2006. New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008, 50.

  107. 107.

    Ibid.

  108. 108.

    B. Sadrizadeh, “Letter to Dorothy Blake, Re: Committee of Cosponsoring Organization (CCO), 24 October 1996, New York,” Geneva: World Health Organization, 1996, A21/87/3.

  109. 109.

    George Alleyne, Interview by Michael Merson, New Haven, CT, August, 2002.

  110. 110.

    Mina Mauerstein-Bail, Interview by Michael Merson, New Haven, CT, October, 2001.

  111. 111.

    Peter Piot, No Time to Lose: A Life in Pursuit of Deadly Viruses. New York: Norton, 2012, 249.

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Authors and Affiliations

  1. Duke Global Health Institute, Duke University, Durham, NC, USA

    Michael Merson (Wolfgang Joklik Professor of Global Health)

  2. Mount Saint Mary’s University, Los Angeles, CA, USA

    Stephen Inrig (Director, Health Policy and Management Program)

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Merson, M., Inrig, S. (2018). UNAIDS: Trying to Gain Traction. In: The AIDS Pandemic. Springer, Cham. https://doi.org/10.1007/978-3-319-47133-4_17

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