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The Joint United Nations Program on HIV/AIDS (UNAIDS) was launched
in January 1996 to coordinate a broad-based response to the AIDS
epidemic in areas ranging from health to economic development and
to act as the main advocate for global action on HIV/AIDS. The program
is cosponsored by seven organizations: WHO, UNDP, UNICEF, UNESCO,
UNDCP, UNFPA, and the World Bank. The Executive Director of UNAIDS
is Dr. Peter Piot of Belgium.
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estimates that 34.3 million people are now living with HIV. |
Since the AIDS (Acquired Immunodeficiency Syndrome) epidemic first
emerged during the 1980s, it has turned into one of the most significant
international health challenges facing thenternational community.
The potential consequences of the pandemic led the World Health
Organization to set up a Global Program on AIDS (GPA) in 1988 to
develop and coordinate a global strategy to fight the disease. Other
UN agencies also established their own programs to fight the epidemic.
In 1993, the World Health Assembly called for a joint and cosponsored
UN program on AIDS to ensure coordination and coherence in the various
AIDS programs within the United Nations, and to prevent a duplication
of efforts. A transition team, drawn from the six participating
agencies, began work in Geneva in late 1994 and UNAIDS formally
commenced work as an interagency body at the beginning of 1996.
AIDS is a naturally occurring disease which destroys the body's
immune system. It starts with infection (usually transmitted through
sexual intercourse or contact with infected blood, but also from
mother to child) with the Human Immunodeficiency Virus (HIV). This
eventually causes AIDS - a nearly-always fatal disease since victims
can no longer develop an effective immune response to other diseases.
Tuberculosis is the number one killer of HIV-positive people, and
UNAIDS has warned of a "dual epidemic" since TB can spread
through the air to both HIV-positive and HIV-negative people. In
many countries the AIDS virus is the major cause of big increases
in TB incidence over the last ten years.
UNAIDS estimated in mid-2000 that 34.3 million people (including
1.3 million children under 15) were living with HIV, and that 18.8
million had lost their lives to the disease since the beginning
of the pandemic. During 1999, 2.8 million people died of AIDS and
5.4 million were newly infected with the HIV virus which causes
it. The brunt of the pandemic is being borne by the developing world,
which already accounts for more than 90 percent of all HIV infections.
Two-thirds of all the people living with HIV in the world live in
sub-Saharan Africa. In 16 African countries, at least 10 percent
of the adult population is infected with HIV, and in Botswana one
out of every three adults is infected.
In mid-2000 there was still no sign of a cure for AIDS or for infection
with HIV, and no expectation of an effective vaccine against AIDS
becoming available in the immediate future, although the first human
vaccine trials commenced in 1987. In the last several years some
new substances have had a dramatic impact on slowing the progression
of the disease but not curing it. Since 1996 a multidrug treatment
regime known as HAART (Highly Active Anti-Retroviral Therapy) has
proven extremely effective in allowing people with AIDS to battle
opportunistic infections and lead close-to-normal lives. However
problems with HAART have become apparent, including the failure
of patients to comply with a very complex treatment regime and metabolic
disbalances caused by the "protease inhibitors," a key
element of the treatment. Furthermore, HAART, which costs around
$10,000 a year, is not affordable in much of the developing world
and it thus not available to the vast majority of people with AIDS.
"Bridging the Gap" between the developed and developing
world in AIDS prevention, care and treatment was the theme of the
12th World Conference on AIDS held in Geneva in June 1998.
The most immediate goal of the UNAIDS program is to prevent HIV
transmission, essentially through education and information exchange
on AIDS, and public information campaigns on how the virus is spread
and on how to prevent becoming infected. The virus is transmitted
through sexual intercourse, exposure to infected blood (through
contaminated needles, syringes or blood products), and can be spread
from infected mother to infant before birth, during delivery or
during breast feeding. In 1996, UNAIDS launched a major program
to promote the use of the female condom in developing countries
based on a special pricing agreement it negotiated with a female
condom manufacturer. Since then over 12 million female condoms have
been sold in 60 developing countries.
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Preventing
Mother to Child Transmission
Since 1994 it has been known that the antiretroviral
drug zidovudine or AZT can reduce the risk of mother-to-child
transmission by up to two-thirds when given to infected women
during pregnancy, labor and delivery and to the newborn for
six weeks after birth. However the AZT regime is estimated
to cost at least $ U.S. 800 per pregnancy which is 80 times
the annual health budget per person in many developing countries.
Also making such treatment difficult or impossible in the
developing world is the fact that many pregnant women do not
have access to medical care until late in pregnancy, if at
all. As a result, 1,000 infected babies are born every day
around the world, despite the existence of a known-effective
treatment.
Early in 1998, the U.S. Centers for Disease
Control announced that a short course of AZT given late in
pregnancy and during delivery could reduce mother-to-child
transmission by half. This finding from a CDC study conducted
in collaboration with the Ministry of Public Health of Thailand
offered the first realistic therapy option for preventing
mother-to-child transmission in the developing world. Shortly
after publication of the finding, UNAIDS convened a meeting
of international agencies and interested governments to find
ways of rapidly implementing the results of the trial into
public health policy in developing countries.
Results of other short course regimes have
since been reported, most recently an intervention of one
dose of nevirapine to the mother during labor and to the baby
after birth. The UN has established an interagency task team
to help countries implement these interventions, and the manufacturers
of AZT and nevirapine have offered to make available these
medicines free of charge or at discounted prices. As of mid-2000,
24 countries were implementing pilot programs for the prevention
of mother-child transmission.
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UNAIDS is also seeking to accelerate work on the development of
a vaccine. To help pave the way toward large-scale vaccine trials,
UNAIDS has drawn up a set of ethical guidelines designed to protect
the rights of those taking part in international vaccine trials.
The guidelines, released in June 1998, reinforce the need to obtain
individual informed consent, and deal with difficult ethical issues
including the need to ensure HIV preventive measures and counseling
for all those participating in the trials. UNAIDS has also proposed
that populations who participate in research should be the first
to benefit from it, perhaps through some form of early and preferential
access if an effective vaccine can be developed. The first phase
1 human trial was conducted in 1987 in the US. In mid-2000 there
were only two ongoing Phase III trails (involving thousands of volunteers)
-one in the US which began in June 1998 and one in Thailand which
began in March 1999. The initial results of those trials are expected
by end 2001 or early 2002.
The role of WHO and UNAIDS is to facilitate trials in developing
countries by helping them develop the scientific infrastructure
needed to conduct the trials.
U.S. contribution: The United Sates has been the single largest
donor to UNAIDS to date, amounting to about one-quarter of the total
UNAIDS budget.
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U.S.
Efforts on HIV/AIDS
The United States has invested more than
$1.4 billion in international AIDS programs since the start
of the epidemic. The following are excerpts from a fact sheet
released by the U.S. Department of State in September 2000
for the Millennium Summit detailing U.S. international efforts
to help fight HIV/AIDS.
On January 10, 2000, Vice President Gore chaired
the first-ever United Nations Security Council Panel session
on a health issue: HIV/AIDS as an international security threat.
In his year 2000 State of the Union address,
President Clinton announced the administration's Millennium
Vaccine Initiative to accelerate the development of malaria,
TB and AIDS vaccines - vaccines for which there is an enormous
need, but little market incentive for industry to develop.
The initiative calls for:
- $50 million in the President's 2001 budget
as a contribution to the vaccine purchase fund of the Global
Alliance for Vaccines and Immunization (GAVI);
- U.S. leadership in the World Bank and
other multilateral development banks to dedicate an additional
$400 million to $900 million annually of low-interest rate
loans to health care services;
- significant increases in basic research
on diseases that affect developing nations;
- $1 billion tax credit for sales of vaccines
for malaria, TB and AIDS to accelerate their development
and production.
On May 10, 2000, the President signed an
Executive Order to help make HIV/AIDS-related drugs and medical
technologies more affordable and accessible in beneficiary
sub-Saharan African countries. Earlier this summer, the pharmaceutical
industry announced an initiative to reduce prices for antiretroviral
drugs for developing countries.
The Clinton administration:
- is investing $2 billion annually for AIDS
research, with over $210 million allocated to AIDS vaccine
development - the best hope for conquering the disease;
- made global AIDS and infectious diseases
a top priority at the U.S.-European Union Summit in Portugal
in May 2000 and the July 2000 G-8 Summit in Okinawa, where
billions of dollars were mobilized from G-8 partners.
- President Clinton has asked Congress for
an increase of $100 million - to $342 million - for international
AIDS prevention and care in fiscal year 2001, more than
double the FY 1999 level. Funds will be targeted to the
countries where the disease is most widespread, particularly
in sub-Saharan Africa. Priorities include stepped-up primary
AIDS prevention efforts; care and treatment; care for children
orphaned by AIDS; and strengthening the public health infrastructure
that can prevent and control the disease.
- In August 2000, President Clinton signed
into law HR 3519, the "Global AIDS and Tuberculosis
Relief Act of 2000," which authorizes funding for AIDS
prevention and treatment programs worldwide and increases
investment in vaccines for the world's children.
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Internet
www.unaids.org
Description of UNAIDS and its programs, press releases, reports,
including the AIDS Epidemic Update, examples of best practicesin
AIDS prevention, country by country statistics and surveillance
reports.
Address
UNAIDS
20, avenue Appia
CH-1211 Geneva 27
Tel: 791.3666
Fax: 791.4187
E-mail: unaids@unaids.org
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