The United Nations at work: the fight against AIDS
The United Nations has supported a wide range of activities and initiatives around the world in its battle against HIV and AIDS. The creation of a coherent and effective long-term campaign against the epidemic has been given new impetus by the UN Secretary-General's call to action against HIV/AIDS and the proposed global fund on AIDS and health. The following are a few examples of the UN's work to broaden partnerships, encourage prevention, promote care and treatment, mobilize resources, and grapple with issues of AIDS and food security, human rights, and workplace policies. —UNAIDS—was created in 1996 to help meet that challenge.
- The UN has been active in the struggle against AIDS since the early days of the epidemic. In 1987, the World Health Organization (WHO) took the lead responsibility in the UN on AIDS by setting up a Special Programme on AIDS, which soon became the Global Programme on AIDS. At its World Health Assembly in 1993, WHO outlined the need for a joint programme on HIV/AIDS that would coordinate the activities of other UN bodies against the epidemic. This resulted in the creation of the Joint UN Programme on HIV/AIDS (UNAIDS), which has been operating since 1996.
- UNAIDS and its Cosponsors, as well as other members of the UN family, are supporting ground-breaking initiatives in many countries around the world and have laid the foundation for the intensified campaigns that are now being mounted.
- The UN's role, and particularly that of UNAIDS, in partnership with other players, is to provide governments with the necessary technical and institutional support and information needed to respond effectively to the epidemic.
- As the main advocate for global action on HIV/AIDS, UNAIDS leads, strengthens and supports an expanded response to the epidemic. In particular, it supports the strengthening of HIV/AIDS-related planning, policy coordination and strategy development within the UN system. As well, it supports national leadership on HIV/AIDS, especially through strengthened national coordination mechanisms and national strategic plans. Its work emphasizes support for country-led processes.
- Importantly, UNAIDS works also to mobilize the UN system and to help bring focus and coherence to its activities against HIV/AIDS. This coordination is now being achieved through the UN System Strategic Plan for HIV/AIDS, which links the operational work of individual UN agencies to the overarching UN objective of providing leadership and adding value to the work of national governments and other partners in achieving agreed goals. Participating in the plan are 29 UN organizations.
- In that context, various branches of the UN-such as the Security Council and Economic Commissions-are intensifying their contributions to the struggle against AIDS. For example, the African Development Forum, which was organized by the UN Economic Commission for Africa in Addis Ababa in December 2000, brought together leaders from the continent to commit themselves to strategies to halt the epidemic's advance. The UN also supports efforts by other regional and international groupings to intensify their action against the epidemic. In the Caribbean region, the Pan-Caribbean Partnership Against HIV/AIDS has emerged as a key player in the struggle against HIV/AIDS, and is working with UNAIDS, and others.
- Prominent among the partnerships assembled to fight the epidemic is the International Partnership against AIDS in Africa (IPAA)-a coalition that works under the leadership of African governments and harnesses the resources of the United Nations, donors, and the private and community sectors. The venture harnesses the strengths of its partners, with UN organizations providing support to country-level efforts.
- On the corporate front, the skills and strengths of the business community are being harnessed in creative ways that go beyond financial contributions. As an example of the 'multiplier effect' of working with a large, global company, UNAIDS has teamed up with MTV to promote HIV/AIDS awareness to its one billion young viewers around the world. Initiatives are also being mounted in partnership with the Global Business Council on HIV/AIDS, a group of 15 large companies that are advocating a stronger business response to HIV around the world. The United Nations Industrial Development Organization (UNIDO) is also involved in mobilizing the business comunities in several countries to support HIV/AIDS activities.
- The UN system recognizes the value of encouraging volunteers in its outreach work against HIV/AIDS. The UN Volunteers, together with UNAIDS and UNDP, has launched a unique pilot project to enlist people living with HIV/AIDS to work as national UN volunteers in their own communities. Among other things, the project helps set up support groups for AIDS orphans and their foster parents. It also provides technical assistance to help communities produce their own publications on HIV/AIDS.
- In order to help protect young people against HIV, UNESCO provides planners and decision-makers with prototype educational material and organizes workshops for sharing experiences and knowledge. Since effective HIV/AIDS education must be country-driven, UNESCO also provides countries with expertise to help them assess their situations and develop national preventive education strategies.
- Since 1994, UNDCP has supported a successful project of the Brazilian Ministry of Health to prevent drug use and HIV infection. The project targets "at-risk" teenagers, as well as injecting drug users, and has reached more than 100,000 students and provided preventive education and care to about 80,000 drug users.
- The UNAIDS Secretariat is supporting the Open Society and Medecins sans Frontieres' large-scale prison programme in Belarus, Estonia, Latvia, Moldova, Poland and Russia. The aim is to train prisoners as peer educators, provide counselling for injecting drug users, offer confidential and free HIV testing, train administrative staff and police, as well as distribute condoms, and where feasible, clean needles or bleach in prisons.
- Young people who inject drugs and workers in the sex industry are being targeted in programmes such as those run by the UNICEF-sponsored Vera, Madeshda, Ljubov ('Faith, Hope and Love') NGO in Ukraine. This initiative offers people the information and means to protect themselves against infection, provides psychosocial and medical support, and tries to inculcate a more caring approach among law enforcement personnel. In Brazil, activists and politicians helped win laws forcing local governments to fund outreach programmes for injecting drug users, with support from UNAIDS and UNDCP. Also included are AIDS education, condom promotion, needle exchange and drug treatment.
- In Nigeria, UNFPA supports a television programme, 'I Need to Know', which airs on 20 television stations across the country. The programme is helping adults realize that silence can be deadly, and is encouraging young people to speak out and ask questions of their elders on topics often considered 'off limits'. Supported by UNESCO, the NAZ Foundation (India) Trust is training young peer educators to raise awareness on HIV/AIDS and promote safer sex practices at colleges in New Delhi.
- In Brazil, a UNDCP-supported project has provided more than 100,000 school students with information on health promotion, drug abuse risks and the prevention of sexually transmitted diseases, particularly HIV/AIDS. The project has been extended to four other South American countries, while similar projects have been developed at the other end of the world-in Kazakhstan, Myanmar and Viet Nam.
- The UN Foundation's multimillion-dollar youth and HIV/AIDS initiative in southern Africa, undertaken in collaboration with UN agencies and local NGOs, has introduced multiple prevention projects in each country. In Zimbabwe, for instance, the emphasis is on adolescent girls, peer education and microcredit schemes, as well as boosted community support for orphans. A further region-wide project, 'Telling the Story', publicizes the initiatives in neighbouring countries, thereby providing an opportunity to compare different projects within the same region.
- Because of the vulnerability of merchant sailors to HIV, the UN Economic Commission for Asia and the Pacific, the Thai Business Council on AIDS and the Thai Red Cross have arranged for information on HIV/AIDS to become part of the curricula at maritime colleges. The project will be extended to other Thai colleges. Later, HIV/AIDS awareness will be taught on-board ships. Similarly, the World Food Programme is conducting, as a pilot programme, interventions that include using its extensive logistics network to support HIV/AIDS education and risk reduction activities for contracted transport workers.
- Other UN organizations and agencies are involved in a host of HIV/AIDS activities. The Office of the United Nations High Commissioner for Refugees (UNHCR) is strengthening HIV/AIDS prevention and care components of reproductive health programmes in refugee settings, especially in the Great Lakes Region and West Africa. The United Nations Research Institute for Social Development (UNRISD) is generating new knowledge about the course and consequences of the epidemic, as well as new ideas on bolstering countries' responses. The United Nations Development Fund for Women (UNIFEM) is engaged in programmes aimed at integrating gender issues into national HIV/AIDS plans and initiatives.
Care and treatment
- In May 2000, UNICEF, UNFPA, WHO, the World Bank and the UNAIDS Secretariat began the accelerating access initiative to support countries that are trying to set up national action plans that incorporate comprehensive care programmes for people living with HIV/AIDS.
- Reducing mother-to-child transmission is an essential part of a comprehensive approach to care and treatment. The UN Inter-Agency Task Team on Mother-to-Child Transmission is supporting pilot projects to prevent this form of transmission in Botswana, Burundi, Cambodia, Côte d'Ivoire, Honduras, Kenya, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe. Targeting antenatal clinics, they combine voluntary counselling and testing of mothers with the provision of antiretroviral drugs, self-delivery practices and infant-feeding counselling.
- An estimated 13 million children, most of them in Africa, have lost a mother or both parents to AIDS since the epidemic began. Chikankata Health Services, a church-based organization in central Zambia, is one of many projects that are providing support to orphans in Africa. Its staff set up the Community-Based Orphan Support Project in 1995, with support from UNICEF, to offer educational and medical support to orphans from five local villages. Today it takes care of 1,500 orphans.
- HIV/AIDS organizations world-wide and the UNAIDS campaign to widen and speed up access to treatment have helped lower the prices of some antiretroviral drugs and HIV-related medicines. Ongoing negotiations are maintaining that momentum. Generic manufacturers have also joined the effort to cut prices and widen public access to life-saving drugs.
- The UNDP-supported 'National Human Development Report for Botswana' in 2000 focused on HIV/AIDS and provided both policy guidance and a boost for political action at the highest levels. The report spurred a public discussion on the accessibility of antiretroviral drugs and on whether the government was responsible for providing them.
- Worried by the growing impact of the epidemic on food security and the rural sector, the UN Food and Agriculture Organization (FAO) is developing guidelines to incorporate an HIV/AIDS dimension in all its relevant field activities, especially agricultural investment projects. FAO is also developing nutritional guidelines for people living with HIV/AIDS for use by community-level health staff and other extension workers. It is also devising strategies to combat food insecurity among AIDS orphans living in rural areas. The World Food Programme, meanwhile, is using food aid to improve the food security of HIV/AIDS families and orphans.
- FAO has also been studying the impact of HIV/AIDS on agriculture, rural development, nutrition and food security, with a focus on sub-Saharan Africa. The studies examine the impact of the epidemic on agricultural extension work in Malawi and Zambia, the livestock sector in Namibia, the interrelationships between HIV/AIDS and emergency situations, and the socioeconomic impact of the disease in rural parts of Niger.
HIV/AIDS and human rights
- Guidelines were called for by the UN Secretary-General to serve as a framework for discussing human rights considerations in the fight against HIV/AIDS at the national, regional and international levels. The guidelines were developed and published jointly by the Office of the High Commissioner for Human Rights and UNAIDS in 1998, and have been used as the basis for subsequent resolutions of the UN Commission on Human Rights concerning human rights and HIV/AIDS.
HIV/AIDS in the workplace
- The ILO has developed a 'Code of Practice on HIV/AIDS and the World of Work' to offer guidance on issues involving HIV/AIDS and the workplace. It will be promoted for use by ministries of labour, employers' bodies and workers' unions.
- The ILO is also working to incorporate workplace policies into national action plans against HIV/AIDS and to integrate HIV/AIDS issues into all its programmes at both national and enterprise levels.
- Between 1996 and 2000, the World Bank committed approximately US$493 million for new HIV/AIDS components and stand-alone projects in 39 countries. By the end of this fiscal year, the Bank will have committed an additional US$740 million for new HIV/AIDS prevention and care efforts, mostly in sub-Saharan Africa.
- The Bank has expanded its activities. In September 2000, it launched the first phase of the Multi-country AIDS Programme (MAP) for Africa, in collaboration with UNAIDS, the International Partnership Against AIDS in Africa, key bilateral donors, and leading NGOs. The first phase of the programme has made US$500 million in credits available to African countries to expand their national prevention care and treatment programmes. The Bank has now begun preparing the second phase of this programme, which will mobilize another $500 million in credits. A similar initiative is planned for the Caribbean.
- The Bank is supporting the inclusion of HIV/AIDS in poverty reduction strategies and debt relief programmes. It also performs economic research on the macro and micro dimensions of the epidemic and, along with UNAIDS partners, governments, the private sector and civil society, is working to help speed up vaccine production, reduce ARV drug prices, mobilize resources, and create a global fund.
- In March 2000, Malawi recruited the help of UNDP to organize a 'resource mobilization roundtable', which brought together NGOs, senior state officials and development agencies-underlining the government's bid to expand its response into all sectors. The round table resulted in US$110 million in pledges, a firmer relationship between donors and the government, and many new partnerships.
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