UNAIDS at country level

In developing countries, UNAIDS operates mainly through the country-based staff of its seven Cosponsors (see Panel). Meeting as the host country’s United Nations Theme Group on HIV/AIDS, representatives of the Cosponsoring organizations share information, plan and monitor coordinated action between themselves and with other partners, and decide on joint financing of major AIDS activities in support of the country’s government and other national partners. The principal objective of the Theme Group is to support the host country’s efforts to mount an effective and comprehensive response to HIV/AIDS.

The UNAIDS Cosponsors

Working singly, jointly and with the UNAIDS Secretariat, the seven Cosponsoring organizations of UNAIDS offer countries a broad range of experience, efforts and resources of relevance to the fight against the epidemic.

UNICEF, the United Nations Children’s Fund, mobilizes the moral and material support of governments, organizations and individuals worldwide in a partnership committed to giving children a first call on society’s resources in both good times and bad. A decentralized operational agency, UNICEF works with governments and NGOs to improve the lives of children, youth and women. The epidemic is having a significant impact on adolescents, and adolescence is both a period of increased risk and a window of opportunity to develop the skills, attitudes and behaviour needed to prevent HIV infection in adulthood. UNICEF’s priority programme areas in HIV/AIDS include youth health, school AIDS education, communications, assistance to children and families affected by AIDS, and the prevention of mother-to-child HIV transmission.

UNDP, the United Nations Development Programme, supports countries in strengthening and expanding their capacity to respond to the development implications of the HIV/AIDS epidemic. UNDP emphasizes support to initiatives which catalyse community and national mobilization; create a supportive ethical, legal and human rights framework; are gender sensitive; empower people to take charge of their own wellbeing, drawing on local resources and building on local knowledge and values; and foster an enabling political, economic and social environment. UNDP is responsible for assisting the Secretary-General in strengthening the Resident Coordinator system through which the UN Theme Groups on HIV/AIDS operate.

The mandate of UNFPA, the United Nations Population Fund, is to build the knowledge and capacity to respond to needs in population and family planning. Reproductive health is a major focus of UNFPA support and includes family planning and sexual health, of which HIV prevention is an integral component. In its reproductive health activities, UNFPA gives special attention to adolescents; to information, education and communication; and to the training of service providers. Among other things, UNFPA brings to UNAIDS a network of country-level offices which support national reproductive health programmes, its expertise in reproductive health promotion and service delivery, with a special focus on the needs of women, and its experience in logistics management of contraceptives, including condoms.

The United Nations International Drug Control Programme, UNDCP, which became a UNAIDS Cosponsor in April 1999, is responsible for coordinating and providing effective leadership for all United Nations drug control activities. Because HIV spreads through drug use, both via shared injection equipment and as a result of the disinhibiting effects of drugs on sexual behaviour, international drug control is a vital tool for HIV prevention. In this context UNDCP is active in supporting HIV/AIDS prevention programmes and including prevention in its own programmes to reduce the demand for illicit drugs. Youth and high-risk groups are of particular concern.

The mandate of UNESCO, the United Nations Educational, Scientific and Cultural Organization, is to foster international cooperation in intellectual activities designed to promote human rights, to help establish a just and lasting peace, and to further the general welfare of mankind. Thus, the ethical imperative is central to UNESCO’s mandate.

In its fields of competence – education, science, culture and communication – UNESCO can bring the vast network of institutions with which it collaborates into the fight against AIDS.

WHO, the World Health Organization, is the directing and coordinating authority on international health work. In 1986, WHO established the Special Programme on AIDS, later renamed the Global Programme on AIDS, which was dismantled in 1996 with the creation of UNAIDS. Through WHO’s new Initiative on HIV/AIDS and sexually transmitted infections (STIs), the Organization contributes by providing countries with expertise in areas relevant to the health sector. These areas include: strengthening HIV and STI prevention (particularly for those vulnerable and/or at increased risk); ensuring safe blood supplies; surveillance of HIV, AIDS and STIs; developing health policies and standards; planning of integrated services; caring for people with STIs, HIV or AIDS; and evaluating STI/HIV policies and programmes.

The mandate of the World Bank is to alleviate poverty and improve quality of life. HIV/AIDS entails an enormous loss of human and economic resources and poses a substantial threat to the economic and social growth of many nations in the developing world. Between 1986 and early 1999, the Bank disbursed over US$750 million for more than 75 HIV/AIDS projects worldwide. Most of these resources were provided on highly concessional terms through the International Development Association. In its policy dialogue with borrowing countries, the Bank stresses that the epidemic is a development priority and highlights the need for top-level political commitment, systematic health sector reforms, human rights protection, and a range of multisectoral reforms to help reduce the factors contributing to HIV spread. Whenever possible, other Cosponsors or members of the UNAIDS Secretariat provide technical assistance to Bank-assisted activities.

In most cases, the host government is invited to be part of the Theme Group. Increasingly, other partners such as representatives of other United Nations agencies and bilateral organizations working in the country are also included.

In priority countries the Theme Group has the support of a UNAIDS staff member, called a Country Programme Adviser (CPA). Elsewhere, a staff member of one of the seven Cosponsors serves as the UNAIDS focal point for the country. In addition to supporting the UN system, these staff endeavour to build national commitment to AIDS action and provide information and guidance to a range of host country partners, including government departments and groups and organizations from civil society, such as people living with HIV/AIDS.

Figure

The UNAIDS Secretariat makes catalytic funding available for selected AIDS initiatives. Between January 1998 and May 1999, proposals were received and approved for projects in a total of
87 countries.

As of April 1999, the UNAIDS Cosponsors had established 132 United Nations Theme Groups on HIV/AIDS covering 155 countries. For their day-to-day operations, most Theme Groups have set up special working groups that involve donors, NGOs and groups of people living with HIV/AIDS.

HIV/AIDS: a still-emerging epidemic

In the industrialized world, where AIDS was identified almost two decades ago, treatment advances have led many people to assume that the epidemic is over. The facts tell us otherwise. New combination therapies have improved the quality of life and extended the survival of people with HIV, but they are far from a cure. The new antiretrovirals are expensive and often produce serious side effects. No one can predict how long their beneficial effects will last in a given patient, or how quickly the virus may mutate, becoming resistant to the drugs.

Most importantly, while the industrialized world chalked up important prevention successes in the 1980s, prevention has stagnated during the past decade. The yearly figures for new infections are staggering. In 1998, an estimated 75 000 people became infected in North America, Western Europe and the industrialized nations of Asia alone.

Figure

But the HIV/AIDS burden weighs most heavily on the developing world, which now accounts for over 95% of people currently infected and for 95% of the lives claimed by AIDS since the start of the epidemic.

In Latin America, infections with HIV are on the rise among women, poor and under-educated population groups, men who have sex with men, and people who inject illicit drugs. The Caribbean region shows some of the highest HIV rates in the world outside Africa.

HIV did not arrive in Asia, home to half the world’s population, until the late 1980s and early 1990s. Today, the region accounts for 20% of all infections worldwide. Cambodia and Thailand are among the countries with the highest HIV incidence rates, although the rates in Thailand have receded thanks to a strong prevention programme. Experts worry about the potential for epidemic expansion in China and in the other giant of the region, India, where more than 4 million people have already been infected – the largest number of infected individuals in any single country in the world.

Central Europe and the former Soviet Union had hardly any HIV infections just a few years ago. Now, in places where health and social structures have crumbled, HIV is spreading rapidly through injecting drug use and through commercial sex. In some countries, infection rates have more than tripled since 1994.

Like the industrialized world, sub-Saharan Africa is struggling with an epidemic that is now entering its third decade. But, while a few African countries have succeeded in stabilizing or reversing HIV infection rates, the epidemic is out of control in many places, especially in the southern part of the continent.

· AIDS is now the leading cause of death in Africa. In 1998 alone, two million people died of AIDS in the African countries south of the Sahara, and millions of new HIV infections occur there every year, foreshadowing even greater losses in the future.

· In the world’s nine most severely-affected countries (all of them located in Africa) where at least one-tenth of the adult population has HIV, life expectancy for a child born in 2000-2005 will drop to 43 years from the pre-AIDS expectation of 60 years of life.

The resulting impact on households, farms, businesses, schools and the economy as a whole is devastating (see Chapter 5). In many places, AIDS has become the single biggest threat to human and socioeconomic development.