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UNAIDS mobilizes political commitment from national leaders, encourages countries to mount a broad-based response to AIDS, brings new partners to the fight against AIDS, and helps break the conspiracy of silence that can surround the AIDS epidemic. Creating synergy and bringing an expanding array of sectors and partners together to address HIV/ AIDS is the key to success.

Mobilizing national leadership

Denial and complacency about AIDS affect not only individuals and communities, but political leaders as well. Countering the forces of denial requires continuing and persistent advocacy. Working with local experts, NGOs, and people living with HIV/AIDS, the UNAIDS Cosponsors and Secretariat have helped to put AIDS high on the national political agenda on every continent.

AIDS issues have also been successfully introduced into the agendas of regional political bodies such as the Economic Commission for Africa (ECA), the South Asian Regional Development Council, the Caribbean Community Secretariat (CARICOM), and the Association of South-East Asian Nations (ASEAN). The epidemic and UNAIDS have been mentioned repeatedly in communiquof the group of eight most industrialized countries (G-8). UNAIDS collaborates with parliamentary leaders and members, and with the Inter-Parliamentary Union, which has adopted resolutions on AIDS prevention and on non-discrimination.

· In November 1998, in India, home to at least 4 million persons with HIV, Prime Minister Vajpayee gave a watershed address to members of Parliament and the press. He spoke of the threat the epidemic posed to India, but also of the need for compassion and acceptance for people living with HIV, and for the protection of human rights, and he opposed mandatory HIV testing.

The United Nations’ contribution to India’s reinvigorated national response to AIDS includes successful efforts to build a working partnership between the Government, the organizations of the United Nations system, and bilateral agencies and donors for the purpose of international technical collaboration.

With primary support coming from a new World Bank credit of over US$ 200 million, India’s prevention efforts focus on behavioural risks and on AIDS stigma that increases vulnerability to HIV. The United Nations system staff support a wide range of “consortia” - national groups that bring together Indian expertise from Government and civil society and link them with international partners. Bilateral donors, such as the United Kingdom Department for International Development (DFID), the United States Agency for International Development (USAID), the Canadian International Development Agency (CIDA), and the Swedish International Development Cooperation Agency (SIDA), increasingly provide support to the international collaboration framework.

A recent study comparing the degree of political support for AIDS efforts in several Latin American countries - from the community level to the national government - found a greater increase in political support in countries such as Guatemala where the United Nations Theme Groups on HIV/AIDS were most active.

· The 1999 World AIDS Campaign was launched in Brazil by President Cardoso in the presence of Vice-President Maciel, cabinet ministers, members of the international diplomatic corps and representatives of United Nations agencies. At the launch, President Cardoso made a public commitment not to cut funding for the national AIDS programme despite Brazil’s economic difficulties.

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In Eastern Europe and the countries of the former Soviet Union, UNAIDS has helped speed up the normally lengthy process of awareness-building and mobilization of political commitment.

· In Belarus, the first signs of an HIV epidemic among drug users were reported in the summer of 1996 in Svetlogorsk. An emergency visit to the city organized by the UNAIDS Secretariat and the Theme Group convinced the representatives of five Government ministries that urgent measures were needed, including making sterile injecting equipment available to drug users to reduce the risk of harm from HIV. Before the end of the summer, this harm-reduction policy had been approved by the city council and endorsed by the national Cabinet of Ministers.

· In Moldova, a country where there was public resistance to harm reduction for drug users and to sexual health education in schools, UNAIDS brokered HIV prevention contacts with the Open Society Institute and other partners. In late 1998, the National Security Council overrode legislation prohibiting needle-exchange and endorsed this harm-reduction approach.

In sub-Saharan Africa, significant steps have recently been taken by a number of national political leaders. For example:

· In Botswana, where a full-scale epidemic was once ignored and denied, President Festus Mogae has announced plans for health care and social welfare programmes for people with HIV, as well as measures to prevent mother-to-child transmission. A Parliamentary Task Force on AIDS has been created to link operational-level AIDS work with high-level political commitment.

· Cd’Ivoire, which benefits from both a Theme Group and a UNAIDS Intercountry Team based in Abidjan, has instituted huge annual increases in the country’s AIDS budget since the establishment of UNAIDS in 1996.

· In Tanzania, where approximately 10% of the adult population is already infected, President Mkapa spoke out publicly about the epidemic for the first time in January 1999 - an event that garnered wide media coverage. An Interministerial Technical Committee with leading public figures from all sectors was established and the Prime Minister now holds regular meetings with the UN Theme Group.

· South Africa has broken through its own wall of silence with major speeches on AIDS by then-Deputy President Thabo Mbeke and President Nelson Mandela (see Panel). Deputy President Mbeke addressed the nation in October 1998, launching a partnership against HIV/AIDS which he now chairs through an interministerial committee. President Mandela has also worked with UNAIDS to advocate an expanded global AIDS response.

7-year-old boy living with AIDS, who was publicly blessed by Pope John Paul II.

Heads of state are not the only ones whose leadership is needed. City leaders also have a major role to play. HIV rates are typically highest in urban areas, where demographic growth is also highest. The Alliance of African Mayors and Municipal Leaders, established in Abidjan following a UNDP-organized symposium in December 1997, has committed itself to take on these challenges and pursue intensified action on AIDS prevention and care.

South Africa confronts its epidemic On 1 December 1998, President Nelson Mandela, with Peter Piot, UNAIDS Executive Director, at his side, spoke out in KwaZulu-Natal. Excerpts of his speech follow: Although AIDS has been a part of our lives for 15 years or more, we have kept silent about its true presence in our midst. We want our communities to be able to say to our country: Come and witness the reality of AIDS; see the devastation in our community; see the fresh graves; see the courage of those who live with the infection and of the children who have lost their parents. We must remove the silence that leads companies to say to a newspaper: “We want to put an advertisement in your paper, but it must not be near anything about AIDS.” It is the silence that is letting this disease sweep through our country, adding 1500 people each day to the more than 3 million already infected. Just as we defied the prophets of doom who foresaw endless conflict in our land, we can defeat this terrible disease by all of us accepting responsibility for prevention of infection and for care of those who have been affected. Let us build the Partnership Against AIDS so that it unites every community and sector of our society into a force for change. Let us break the silence by speaking openly and publicly about AIDS, and by bringing an end to discrimination against those living with AIDS. Let us care for those living with HIV/AIDS and the orphans, and give them support, with love and compassion. And let us say that we will wear the Red Ribbon today, and every day, in remembrance of those who have died and in solidarity with those who are infected.

Involving people living with HIV or AIDS

The human desire to deny the enormity of the AIDS crisis is abetted by the fact that infected individuals can look and feel healthy for many years, in effect masking the epidemic. According to conservative UNAIDS estimates, nine-tenths of those living with HIV worldwide do not know they are infected.

One of the best ways of combating denial is to give AIDS “a human face” through what is called the Greater Involvement of People living with HIV/AIDS (GIPA), a principle formally launched at the Paris AIDS Summit on 1 December 1994. People who live with or are directly affected by HIV/AIDS bring personal experience to planning and carrying out a response to the epidemic. Those who are open about their own HIV status can help others come to terms with the invisible HIV risk, and to appreciate the need for solidarity between those living with HIV and those fortunate enough to have escaped infection so far.

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The GIPA principle is strongly endorsed by UNAIDS, whose own governing body - the Programme Coordinating Board - includes representatives of AIDS-related NGOs and people living with HIV/AIDS. On all continents, UNAIDS works to put the principle into practice.

· In Indonesia, where official HIV figures are low and denial of the epidemic still runs strong, people with HIV infection or AIDS are often isolated with little help. UNAIDS Indonesia has provided financial support to allow an organization of people living with HIV/AIDS to strengthen itself institutionally and extend its valuable support and networking activities beyond the capital city of Jakarta. The Theme Group has linked the organization with the country’s policy-makers with whom they are now engaged in constructive dialogue.

· In the Dominican Republic, the Theme Group was instrumental in organizing the national Network of People Living with HIV (Red Dominicano de Personas que viven con VIH/SIDA - REDOVIH). Seed money - US$ 30 000 - from the Theme Group led to the raising of a US$ 500 000 budget that supports Network activities and strengthens the Caribbean Network of People Living with HIV/AIDS. REDOVIH is now a full partner in the country’s National Commission on AIDS.

· Malawi and Zambia were the first countries in the world to take part in a GIPA project started by UNAIDS and the United Nations Volunteers (UNV) that recruits openly HIV-positive people and places them within a host institution, which could be an NGO, a government department, or a private company. In addition to performing regular jobs, their mission is to make HIV/AIDS visible through personal testimony and positive example - using sensitivity training, prevention campaigns, and workplace counselling to bring AIDS into the open and encourage an effective and humane response by governments and civil society.

Promoting broad-based action in countries

Prevention, care, and addressing the impact of the epidemic are tasks for society as a whole, but the health sector has often been left with sole responsibility for dealing with the epidemic. A UNAIDS priority is therefore helping the different sectors in society understand their stake in mounting an effective response to AIDS.

All sectors, whether an education sector where 30% of all schoolteachers are infected, or a defence sector with infection rates of 60% in the military, stand to suffer the impact of an out-of-control epidemic. At the same time, all sectors have regular access to various population groups that they can educate about HIV/AIDS at little extra cost - the education ministry to schoolchildren, the police and military to the troops, the agricultural sector to farming families, the private sector to their own workforce. By tapping into the resources and purses of multiple sectors, a country is in a stronger position to sustain its AIDS response over time.

AIDS-related NGOs have been in the forefront of action since the epidemic began. Alongside these traditional partners, UNAIDS builds bridges to NGOs of other kinds - those not directly involved in AIDS action but working in relevant fields such as the advancement of women, human rights, child welfare, and poverty alleviation.

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Thailand: a classic example of a multisectoral response Thanks to courageous leadership, multisectoral action and decentralization, Thailand is turning around a runaway epidemic. Fewer girls go into the sex trade, brothel visits are down, condom use is up in both commercial and casual sex, and young men are postponing the age at which they first start having sex. In just five years, risk behaviour decreased significantly and the rate of new HIV infections among young men fell dramatically. The key to Thailand’s success is broad-based action implemented on a national scale within a short period of time. Thai society as a whole has worked to integrate a response to AIDS into almost everything, from defence to education, from planning to community development. AIDS is brought into a wide variety of planning and budgeting decisions, be it free education for village girls to discourage families from sending them into sex work, promotion of rural employment opportunities so as to decrease migration to the cities, or free condom distribution in all brothels. Mass media, outreach, counselling and peer education have been used to increase awareness and life skills among young people, those with high-risk behaviours, and the public at large. Figure Thailand’s provinces receive AIDS funding both from the central government and through local taxation. The broad-based response to AIDS in Thailand has involved joint brainstorming, resource contribution, and action by most of the country’s ministries and departments, along with NGOs, businesses, schools, communities and self-help groups of people living with HIV.

Building a chain of commitment in Ukraine In 1996, the chair of Ukraine’s Theme Group brought twelve Cosponsor and donor representatives to Odessa to show them how rapidly HIV was spreading among injecting drug users there. The Theme Group quickly moved to build local resources for prevention, organizing workshops for staff from youth social services, STD clinics, drug clinics and police departments, and recruiting and training over 250 educators. After receiving training, a local police chief started a new AIDS NGO – Truth, Hope and Love. In 1997, the new NGO took on HIV prevention work among drug users and female sex workers in Odessa. Truth, Hope and Love also set up a regional training centre for AIDS prevention among vulnerable groups, with funding from UNAIDS and from the World AIDS Foundation in France. Training requests have come from Moldova and the Caucasus. Having succeeded in building up an association of female sex workers in Odessa, the same NGO worked with UNAIDS staff and the Theme Group to broaden the network through a meeting of sex workers from six Ukrainian cities. Based on this experience, the Theme Group has secured funding from the Ministry of Health of the Federal Republic of Germany to expand the network to 10-15 cities.

The World AIDS Campaign

For over ten years World AIDS Day - 1 December - has served as an international focal point for raising AIDS awareness. UNAIDS has acted to extend the reach and impact of this important opportunity by initiating year-long campaigns that culminate on World AIDS Day. While continuing to serve as a tool for advocacy, these campaigns also provide leverage for the implementation of policies and programmes.

With the first World AIDS Campaign in 1997, UNAIDS and its partners put the international spotlight on children who are infected, at risk of infection or living in families affected by AIDS. A Steering Committee composed of the UNAIDS Cosponsors and four leading institutions in the field advised the Programme on the framework of the Campaign. Reports from countries showed a high level of participation in promoting the objectives of the Campaign, which were as follows:

· increasing public understanding of the impact of the epidemic on children

· involving children and young people in the development of policies affecting them

· improving services and the access of children to prevention and care

· increasing children’s access to quality education and information

· increasing understanding of the interaction between the epidemic of HIV/AIDS and efforts to protect children’s rights.

New infections are increasingly concentrated among younger people. The 1998 World AIDS Campaign Young People: Force for Change addressed the epidemic’s threat to those between 10 and 24 years old, and highlighted the contributions that young people can make to overcoming the epidemic through their energy and commitment and through the adoption of safe behaviour.

· At the launch in Moscow, Russian Federation, the Campaign highlighted the special challenges facing young people in a region where deteriorating health and social structures may increase risk for HIV exposure.

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On World AIDS Day, leaders around the world issued messages of support and announced new measures to combat the epidemic. In Mozambique President Chissano addressed the nation, calling upon young people to organize themselves in churches, residential areas and workplaces to prevent AIDS. In the United Kingdom, Prime Minister Blair stressed his support for young people as a powerful force for change in fighting the spread of HIV and AIDS. In the USA, President Clinton announced a package of US$ 360 million for vaccine and other cutting-edge AIDS research, as well as additional financial support for AIDS orphans worldwide.

· Global media coverage of World AIDS Day reached a potential worldwide audience in the hundreds of millions. Staying Alive, a joint production by UNAIDS, the World Bank and MTV International, was broadcast around the world from morning to night on 1 December.

· Many countries developed peer education and social support services for young people. In Romania, for example, the Romanian Association against AIDS, with financial support from UNAIDS and UNICEF, initiated the Social Centre for People Living with AIDS Project to ensure equitable provision of services, treatment, counselling, and legal and social support to young people living with HIV/AIDS.

· Several countries reported on specific efforts made to promote the genuine participation of young people - with, for example, young people becoming members of United Nations Youth Theme Groups and of development committees for National AIDS Plans.

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At the request of countries around the world eager to reach the age group at highest risk, the 1999 World AIDS Campaign, Listen, Learn, Live! continues to focus on people under 25. Speaking at the world launch in Brasilia in the presence of President Cardoso, UNAIDS Executive Director Peter Piot called on adults to listen to the concerns of young people and help them tackle forces in society, such as violence and machismo, that make them vulnerable to HIV.

The 1999 World AIDS Campaign is an example of true collaboration between UNAIDS Cosponsors, key NGOs working in the fields of children, youth and human rights, and private sector organizations. The special representative of the Campaign, Brazilian football player Ronaldo, also heads the joint UNAIDS/UNICEF “Play Safe” football HIV/AIDS initiative which aims to mobilize organized football to promote HIV prevention messages.

Ronaldo, Special Representative of the World AIDS Campaign, at a press conference at the United Nations in Geneva, December 1998.

Brokering global alliances

UNAIDS has worked to promote pluralistic efforts to address AIDS through a variety of approaches. For example, UNAIDS is committed to building relationships based on mutual respect with religious organizations that can influence the response of individuals and nations to AIDS.

· The UNAIDS Secretariat helped finance and support the First International Symposium on AIDS and Religion in Dakar, Senegal, in November 1997. Participants from a variety of religious backgrounds including Islam, Christianity and Buddhism took this unique opportunity to exchange their practical experience in AIDS care and support and to discuss the always-sensitive issues of prevention through abstinence, mutual fidelity within marriage, and condom use.

· With funding from UNDP, UNICEF, WHO, USAID, and World Learning, Inc., an education NGO, the Islamic Medical Association of Uganda has carried out effective AIDS prevention projects blending Islamic religious values with scientific medical information on HIV/AIDS. The innovative approaches used - including income-generating activities to enhance the position of women - are highlighted in The long jihad: a bitter battle against AIDS, a video produced with the support of the UNAIDS Secretariat.

· In January 1999, UNAIDS signed a memorandum of understanding with Caritas Internationalis, an international Catholic federation of 146 organizations involved worldwide in relief, development and social work. The agreement commits both organizations to cooperation in promoting AIDS awareness, responsible behaviour, and care and dignity for those affected.

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Working with religious leaders in Argentina UNAIDS collaboration with the Roman Catholic Church took a leap forward in Argentina, where the Conference of Catholic Bishops organized a meeting on HIV/AIDS in collaboration with UNAIDS in March 1998. At the time, the Government was concerned about possible opposition to a planned condom promotion and other prevention campaigns supported by a loan from the World Bank. On the other hand, the Church was concerned that its own prevention messages were not reaching the whole population, especially men – whose behaviour was driving the epidemic. Following the 1998 meeting, attended by religious, government and NGO representatives from several Latin American countries and from Portugal, Spain, and the Vatican, the Church – already active in AIDS care and support – stepped up its prevention messages through its own network of schools, broadcast media and institutions. In order to share its practical experience and encourage its sister churches in Latin America to take on similar programmes, the Conference organized a second seminar in March 1999, bringing together high-level ecclesiastical authorities, a representative of the Vatican, and the UNAIDS Secretariat and Cosponsors. Religious institutions represent a major resource in the fight against AIDS. A survey of Roman Catholic churches worldwide, undertaken by His Excellency Archbishop Javier Lozano Barragan, President of the Pontifical Council for Pastoral Assistance to Health Care Workers, showed that in many countries churches account for a quarter of all the AIDS care provided.

UNAIDS works to reduce risk and vulnerability in other institutional settings as well. For example, the Secretariat has developed a partnership with the Civil-Military Alliance to Combat HIV/AIDS to help establish and strengthen AIDS programmes with military services in Africa, Asia and Latin America.

UNAIDS has also reached out to partners in the corporate sector. Alliances have been forged with pharmaceutical companies in a bid to secure lower prices for drugs or devices needed in developing countries. For example, the UNAIDS Secretariat successfully negotiated lower AZT costs for the prevention of mother-to-child transmission, as well as a lower public sector price for the female condom (see Chapter 4) and for HIV-related drugs for pilot projects on care (see Chapter 5).

Broader alliances with industry are aimed at advocacy with, and by, the corporate sector:

· Joint workshops for business leaders in several developing countries have been organized with the Prince of Wales Business Leaders Forum. UNAIDS has also used the network of companies represented by this high-level forum to present a publication on how business can work on AIDS.

· In addition to the half-hour video Staying Alive made with funding from the World Bank, MTV International has worked with the UNAIDS Secretariat to produce publicity spots about HIV/AIDS and an attractive booklet with ready-made media messages that has been distributed worldwide. The President of MTV, Bill Roedy, has become an ambassador for UNAIDS.

· With technical assistance from UNAIDS, Rotary International, which currently involves 9000 Rotary clubs, has published a guide for clubs seeking to work on AIDS, and provided funding to local clubs for activities against the epidemic. The UNAIDS/Rotary International declaration Working together with young people for a safer world has received wide circulation.

The Global Business Council on HIV/AIDS One of many notable elements of the private sector response to the epidemic has been the establishment of the Global Business Council on HIV/AIDS, which UNAIDS has helped launch in November 1997. The Honorary President of the Council is President Nelson Mandela. President Nelson Mandela of South Africa and UNAIDS Executive Director at the World Economic Forum in Davos, 1997. The Council comprises a group of chief executives who represent companies committed to HIV/AIDS causes and who can mobilize and inspire others. By joining the Global Business Council on HIV/AIDS, member companies: · maintain an international focus on the epidemic · learn from each others’ experience of the impact of the epidemic, and exchange ideas towards a more effective response to HIV/AIDS · take visible and effective action, becoming the leading players in helping all their stakeholders (customers, employees and the community) face the challenges of the epidemic · cooperate with other companies in efforts to develop effective international, national or local responses to AIDS.

Mobilizing resources for an expanding epidemic

Twenty years into the epidemic, AIDS is expanding three times faster than the funding to control it.

This sobering conclusion emerges from a study carried out by UNAIDS and the Frans-Xavier Bagnoud Center for Health and Human Rights at the Harvard School of Public Health. The study reviewed donor spending on national, regional and international efforts to tackle HIV/AIDS, as well as national HIV/AIDS spending among developing countries for the years 1996 and 1997.

The study found that the level of support from wealthy countries for the international fight against AIDS is not only inadequate but is being fast outpaced by the epidemic. In 1997, for example, donor nations plus the European Commission provided approximately US$ 150 million for HIV activities to African countries; at that time, there were some 21 million infected Africans and many more at risk. The report also indicates that after a quick influx of donor support, starting in 1990 the increase in annual AIDS funding began to slow. According to global trends in funding over time by an important group of donor countries, the resources made available increased from US$ 165 million to only US$ 273 million between 1990 and 1997, a period during which the number of people living with HIV more than tripled - from just under 10 million to over 30 million.

In the report, 64 developing countries - home to approximately three-quarters of the world’s HIV-positive population - reported allocations of US$ 548.5 million in 1996 from national and international sources, primarily for prevention efforts in country. Of this total, nearly US$ 178 million was provided by United Nations organizations, mostly in the form of loans from the World Bank. The USA was by far the largest donor of HIV-related assistance funds, contributing US$ 137.5 million in 1996 and US$ 135 million in 1997. When official development assistance for AIDS was broken down as a percentage of GNP, however, the Netherlands and Norway were found to be the biggest contributors in both years.

In 29 of the 64 respondent countries, national government funding represented less than 10% of total HIV/AIDS monies. In sub-Saharan Africa, despite the severity of the epidemic there, only Botswana, Kenya, Malawi and Uganda reported spending over US$ 1 million of domestic funds on AIDS activities.

Resource mobilization is becoming an increasing part of the national strategic planning process supported by the Theme Groups. By 1997, almost half the Theme Groups had mobilized funds at country level from Cosponsors, other UN agencies, bilateral donors and the private sector. To assist in this endeavour, the Secretariat is currently preparing detailed guidance on resource mobilization at the country level.

UN partnership in Brazil The Brazilian Government sought UN political support and technical input for the renewal of its World Bank project on HIV/AIDS. According to the UNAIDS-Harvard financing study, the World Bank has become the main external financing source for AIDS action in developing countries. The UN system agencies prepared a workplan in collaboration with the loan renewal project. Along with bilateral organizations, NGOs and the National AIDS Programme, the United Nations Theme Group on HIV/AIDS: · convened a strategic planning workshop on the subject of HIV and children living in poverty · supported a national meeting for the coordination of NGO input into the project · facilitated international technical input. The HIV/AIDS project was successfully renewed for a four-year period and is being funded by a World Bank loan of US$ 165 million and a Government contribution of US$ 135 million. Figure The Theme Group in Brazil also serves as the main forum for coordination between the Government and bilateral agencies. A US$ 10 million USAID project covering prevention, NGO support, and evaluation, coordinated by the Theme Group, is now under way.