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UNAIDS: Finding its Place in Congested Waters

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The AIDS Pandemic

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Abstract

In this chapter, we discuss how the Joint United Nations Programme on HIV/AIDS (UNAIDS) came to define its role and place in a changing donor landscape, including new leadership at the World Health Organization and the United Nations Development Programmme, and the launch of several new initiatives in the global AIDS arena, including the Global Fund to Fight AIDS, Tuberculosis and Malaria, the United States government’s President’s Emergency Plan for AIDS Relief (PEPFAR), and the Bill & Melinda Gates Foundation. Advancements in prevention and treatment have influenced the global response, and UNAIDS has continued to adjust its goals accordingly. In a sea of global AIDS actors, UNAIDS has asserted strong strategic leadership in the areas of advocacy and monitoring and evaluation with the ambitious goal of ending AIDS as a public health problem by 2030.

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.

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

  2. 2.

    Douglas Martin, “Hiroshi Nakajima, Leader of W.H.O., Dies at 84,” The New York Times, January 28, 2013; Craig Turner, “U.N. Health Agency Director Says He’ll Resign,” Los Angeles Times, May 01, 1997.

  3. 3.

    Ken Bernard. Interview by Michael Merson, New Haven CT, February, 2002; Henderson, Ralph. Interview by Michael Merson, NH February 2003.

  4. 4.

    Peter Piot. Interview by Michael Merson, New Haven, CT, October 26, 2002.

  5. 5.

    Global Health-Sector Strategy for HIV/AIDS 2003-2007. Department of HIV/AIDS Family and Community Health, World Health Organization.

  6. 6.

    Bertozzi SM, Martz TE, Piot P. “The evolving HIV/AIDS response and the urgent tasks ahead.” Health Affairs. 2009 Nov–Dec;28(6):1578–90.

  7. 7.

    Ibid.

  8. 8.

    Greg Behrman, The Invisible People: How the U.S. Has Slept Through the Global AIDS Pandemic, the Greatest Humanitarian Catastrophe of Our Time. New York: Free Press, 2004, 160.

  9. 9.

    Ibid, 73.

  10. 10.

    On the role of Ambassador Holbrooke and Senator Frist, see Greg Behrman, The Invisible People: How the U.S. Has Slept Through the Global AIDS Pandemic, the Greatest Humanitarian Catastrophe of Our Time. New York: Free Press, 2004, 158–165, 277–282; On the evolution of Jesse Helms, see Greg Barker, “Interview with Franklin Graham,” in Frontline: The Age of AIDS, ed. Renata Simone (United States, 2006); Cathleen Falsani, “Bono’s American Prayer,” Christianity Today, February 21, 2003; Cathleen Falsani, “Mother Africa,” Christianity Today, February 21, 2003; “Washington Wire,” Wall Street Journal, September 22, 2000, A1; “Names & Faces,” The Washington Post, June 14, 2001, C03; Jesse Helms, Here’s Where I Stand: A Memoir. New York: Random House, 2005; Senator Jesse Helms, “S.2845: An original bill to authorize additional assistance to countries with large populations having HIV/AIDS, to authorize assistance for tuberculosis prevention, treatment, control, and elimination, and for other purposes. 106th US Senate, July 11, 2000; Senator Jesse Helms, “S.AMDT.4018 to H.R.3519: To authorize additional assistance to countries with large populations having HIV/AIDS, to provide for the establishment of the World Bank AIDS Trust Fund, to authorize assistance for tuberculosis prevention, treatment, control, and elimination, and for other purposes,” 106th US Senate, July 26, 2000; Senator Jesse Helms, “S.2943: An Act to authorize additional assistance for international malaria control, and for other purposes,” 106th US Senate, July 27, 2000.

  11. 11.

     S.M. Bertozzi, T. E. Martz, P. Piot. “The evolving HIV/AIDS response and the urgent tasks ahead.” Health Affairs. 2009 Nov–Dec;28(6):1578–90.

  12. 12.

    Greg Behrman, The Invisible People: New York: Free Press, 2004, pp. 207, 209–211.

  13. 13.

    William Clinton, “Statement on Signing the Global AIDS and Tuberculosis Relief Act of 2000, August 19, 2000,” Washington, DC: Government Printing Office, 2000, 1651.

  14. 14.

    Lindsay Knight. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008, 105.

  15. 15.

    Peter Piot, “Commentary: 2001: a turning point in the epidemic,” in AIDS at 30: Nations at the Crossroads. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2011, 23.

  16. 16.

    B. Gellman. “AIDS is declared threat to US national security.” Washington Post, 30 April, 2000 cited in Lindsay Knight,. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008, 108; http://www.gpo.gov/fdsys/pkg/FR-2000-05-12/pdf/00-12177.pdf.

  17. 17.

    Rep James A. Leach. Global AIDS and Tuberculosis Relief Act of 2000 H.R.3519 [IA-1] (introduced 1/24/2000), http://thomas.loc.gov/cgi-bin/bdquery/z?d106:HR03519:@@@D&summ1& accessed on May 31, 2012.

  18. 18.

    J. L. Antunes, E. A. Waldman, C. Borrell, “Is it possible to reduce AIDS deaths without reinforcing socioeconomic inequalities in health?” Int J Epidemiol. 2005 Jun;34(3):586–92.

  19. 19.

    Edwin Cameron, “The Deafening Silence of AIDS,” Plenary Presentation speech transcript for the 13th International AIDS Conference, July 2000.

  20. 20.

    Greg Behrman, The Invisible People: New York: Free Press, 2004, 256; Ken Bernard. Interview by Michael Merson, New Haven CT, February, 2002.

  21. 21.

    Ibid.

  22. 22.

    Peter Piot, “Commentary: 2001: a turning point in the epidemic”, in AIDS at 30: Nations at the Crossroads. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2011, 23.

  23. 23.

    Ibid.

  24. 24.

    S. M. Bertozzi, T.W. Martz, P. Piot. “The evolving HIV/AIDS response and the urgent tasks ahead.” Health Affairs. 2009 Nov–Dec;28(6):1578–90.

  25. 25.

    Peter Piot, “Commentary: 2001: a turning point in the epidemic”, in AIDS at 30: Nations at the Crossroads. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2011, 23; S. M. Bertozzi, T.W. Martz, P. Piot. “The evolving HIV/AIDS response and the urgent tasks ahead.” Health Affairs. 2009 Nov–Dec;28(6):1578–90.

  26. 26.

    Kofi Annan calls for a ‘war chest’ to fight HIV/AIDS globally.” May 11, 2001. C-SPAN. Available at https://www.c-span.org/video/?c4514657/kofi-annan-may-11-2001

  27. 27.

    United Nations General Assembly, “Fifty-fifth session, Agenda item 60(b); 55/2: United Nations Millennium Declaration,” New York: United Nations, September 18, 2000, A/RES/55/2.

  28. 28.

    Lindsay Knight. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008, 110.

  29. 29.

    Declaration of Commitment on HIV/AIDS: United Nations General Assembly Special Session on HIV/AIDS, 25–27 June 2001. New York: United Nations, 2001.

  30. 30.

    Peter Piot, “Commentary: 2001: a turning point in the epidemic”, in AIDS at 30: Nations at the Crossroads. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2011, 23; S. M. Bertozzi, T.W. Martz, P. Piot. “The evolving HIV/AIDS response and the urgent tasks ahead.” Health Affairs. 2009 Nov–Dec;28(6):1578–90.

  31. 31.

    G-8 Communique, Genova, July 22, 2011, paragraph 15.

  32. 32.

    Peter Piot, “Commentary: 2001: a turning point in the epidemic”, in AIDS at 30: Nations at the Crossroads. Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2011, 23.

  33. 33.

    S. M. Bertozzi, T.W. Martz, P. Piot. “The evolving HIV/AIDS response and the urgent tasks ahead.” Health Affairs. 2009 Nov–Dec;28(6):1578–90. J. L. Antunes, E. A. Waldman, C. Borrell. “Is it possible to reduce AIDS deaths without reinforcing socioeconomic inequalities in health?” Int J Epidemiol. 2005 Jun;34(3):586–92.

  34. 34.

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

  35. 35.

    Ibid.

  36. 36.

    Helene Gayle. Interview by Michael Merson, New Haven, CT, February 2002.

  37. 37.

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

  38. 38.

    Helene Gayle. Interview by Michael Merson, New Haven, CT, February 2002.

  39. 39.

    Todd Summers, Lessons from the Global Fund, June 2015 Center for Strategic and International Studies (http://csis.org/files/publication/150624_Summers_LessonsGlobalFundReform_Web.pdf).

  40. 40.

    Stephen Morrison and Todd Summers, “Righting the Global Fund” Center for Strategic and International Studies, February 2012, p. 1. https://csis-prod.s3.amazonaws.com/s3fs-public/legacy_files/files/publication/120228_Morrison_RightingGlobalFund_Web.pdf.

  41. 41.

    The Global Fund. Accessed on April 29, 2017 at https://www.theglobalfund.org/en/

  42. 42.

    A. Usher. “Global Fund replenishment meeting nears target amount.” The Lancet, 388, 10051, 1265.

  43. 43.

    Lindsay Knight. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008, 117–118.

  44. 44.

    Debrework Zewdie. Interview by Michael Merson, New Haven, CT September 2002; Lindsay Knight,. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008, 117–118.

  45. 45.

    Debrework Zewdie. Interview by Michael Merson, New Haven, CT September 2002.

  46. 46.

    Ibid; Lindsay Knight. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008, 117–118.

  47. 47.

    Devi Sridhar, Danielle Kuczynski, and Kristie Latulippe “Background Report for UNAIDS Transition Working Group.” New York and Oxford UK: Center for Global Development, 21–22.

  48. 48.

    The Africa Multi-Country AIDS Program 2000–2006: Results of the World Bank’s Response to a Development Crisis, The World Bank—May 27, 2007.

  49. 49.

    Meeting the Challenge: The World Bank and HIV/AIDS, World Bank, April 2012, 2.

  50. 50.

    PEPFAR. Fiscal Year 2014–2016 PEPFAR Funding; October 2014.

  51. 51.

    www.pepfar.gov/funding/budget.

  52. 52.

    Andrew Green, “Obama Dreams of an AIDS Free Generation,” Foreign Policy, April 18. 2016.

  53. 53.

    S. Resch, Theresa Ryckman, R Hecht, “Funding AIDS programmes in the era of shared responsibility: an analysis of domestic spending in 12 low-income and middle-income countries.” Lancet Global Health 3: 452–461, 2015.

  54. 54.

    PEPFAR web site: http://www.pepfar.gov/funding/index.htm; WHO web site: http://www.who.int/hiv/en/.

  55. 55.

    US President’s Emergency Plan for AIDS Relief, Fact Sheet, 2015 United Nations General Assembly Sustainable Development Summit, September, 2015; http://www.pepfar.gov/documents/organization/247548.pdf.

  56. 56.

    Tulio de Oliveira, et al. “Transmission networks and risk of HIV infection in KwaZulu-Natal, South Africa: a community-wide phylogenetic study.” The Lancet HIV 4.1 (2017): e41-e50.

  57. 57.

    DREAMS: Working Together for and AIDS Free Future for Girls and Women. Washington, DC: PEPFAR http://www.pepfar.gov/documents/organization/252380.pdf accessed on 8 August 2016.

  58. 58.

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

  59. 59.

    Thomas Maugh, “World AIDS plan meets ‘3 by 5’ goal—two years late,” Los Angeles Times, June 3, 2008.

  60. 60.

    Ibid.

  61. 61.

    Udani Samaresekera, “Margaret Chan’s vision for WHO,” The Lancet, 369(9577):1915–1916.

  62. 62.

    David Holmes, “Margaret Chan: Committed to Universal Health Coverage,” The Lancet, September 8, 2012, 380(9845:879; Udani Samaresekera, “Margaret Chan’s vision for WHO,” The Lancet, 369(9577):1915–1916.

  63. 63.

    WHO Department of HIV/AIDS & UNAIDS, The treatment 2.0 framework for action: catalysing the next phase of treatment, care and support. Geneva: World Health Organization, 2011.

  64. 64.

    WHO HIV/AIDS Organigram, September 2014, http://www.who.int/hiv/aboutdept/hiv_organigram_sep2014.pdf?ua=1.

  65. 65.

    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.

  66. 66.

    Bernhard Schwartlander. Interview by Michael Merson, January 3, 2015.

  67. 67.

    Global health sector strategies on HIV, viral hepatitis and sexually transmitted infections, for the period 2016–2021. Sixty-ninth world health assembly. Agenda Item 15.1, WHA69.22 May 28, 2016 http://apps.who.int/gb/ebwha/pdf_files/WHA69/A69_R22-en.pdf.

  68. 68.

    Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. Recommendations for a public health approach-Second Edition. WHOhttp://www.who.int/hiv/pub/arv/arv-2016/en/.

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    R. Sebastian Wanless, John Damonti, Phangisile Mtshali, and Patricia Doykos, “Public-Private Partnerships: From Theory to Practice,” in: Marlink RG, Teitelman ST, eds. From the Ground Up: Building Comprehensive HIV/AIDS Care Programs in Resource-Limited Settings. Washington, DC: Elizabeth Glaser Pediatric AIDS Foundation; 2009. http://ftguonline.org/ftgu-232/index.php/ftgu/article/view/2057/4110, accessed on June 4, 2012.; “Globalization, Partnerships, and Health” in Analysis of experience, pp,10–14.

  70. 70.

    Globalization, Partnerships, and Health” in Analysis of experience, pp,10–14; Ilavenil Ramiah and Michael R. Reich, “Building effective public–private partnerships: Experiences and lessons from the African Comprehensive HIV/AIDS Partnerships (ACHAP),” Social Science & Medicine, July 2006, 63(2): 397–408.

  71. 71.

    M Farahani et al, “Outcomes of the Botswana national HIV/AIDS treatment programme from 2002 to 2010: a longitudinal analysis,” The Lancet Global Health, 2(1):e44–e50, January 2014.

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    “What We Do,” Bill & Melinda Gates Foundation, gatesfoundation.org http://www.gatesfoundation.org/What-We-Do.

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  74. 74.

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

  75. 75.

    Global Task Team on improving AIDS coordination among multilateral donors and international donors.” Geneva: UNAIDS, 2006. http://www.unaids.org/en/media/unaids/contentassets/documents/programmes/programmeeffectivenessandcountrysupportdepartment/GTT_en.pdf Accessed on June 2, 2012.

  76. 76.

    Bob Herbert, “In America: Refusing to Save Africans,” NY Times, June 11 2001.

  77. 77.

    S.M. Bertozzi, T.E. Martz, P. Piot. “The evolving HIV/AIDS response and the urgent tasks ahead.” Health Affairs. 2009 Nov–Dec;28(6):1578–90.

  78. 78.

    Ibid.

  79. 79.

    David I. Watkins “Basic HIV Vaccine Development.” Top HIV Med, Mar 2008,16 (1): 7–8.

  80. 80.

    F.H. Priddy, D. Brown, J. Kublin, K. Monahan, D.P. Wright, J. Lalezari, S. Santiago, M. Marmor, M. Lally, R.M. Novak, S.J. Brown, P. Kulkarni, S.A. Dubey, L.S. Kierstead, D.P. Casimiro, R. Mogg, M.J. DiNubile, J.W. Shiver, R.Y. Leavitt, M.N. Robertson, D.V. Mehrotra, E. Quirk, for the Merck V520-016 Study Group, “Safety and immunogenicity of a replication-incompetent adenovirus type 5 HIV-1 clade B gag/pol/nef vaccine in healthy adults,” Clin Infect Dis. 2008 Jun 1;46(11):1769–81.

  81. 81.

    Peter B. Gilbert, James O. Berger, Donald Stablein, Stephen Becker, Max Essex, Scott M. Hammer, Jerome H. Kim and Victor G. DeGruttola, “Statistical Interpretation of the RV144 HIV Vaccine Efficacy Trial in Thailand: A Case Study for Statistical Issues in Efficacy Trials,” Journal of Infectious Diseases, 203(7): 969–975.

  82. 82.

    HIV Vaccine Research: An Update. May 2016. http://www.avac.org/sites/default/files/resource-files/HIVvax_research_update.pdf.

  83. 83.

    Microbicides for HIV Prevention: An Introductory fact Sheet. April 2016. AVAC Global Advocacy for HIV Prevention. http://www.avac.org/microbicides/basics.

  84. 84.

    Larry Krotz, Piecing the Puzzle: The Genesis of AIDS Research in Africa, Winnipeg, Manitoba: University of Manitoba Press, May 1, 2012.

  85. 85.

    H.A. Weiss, M.A. Quigley, R.J. Hayes. “Male circumcision and risk of HIV infection in sub-Saharan Africa: a systematic review and metaanalysis.” AIDS. 2000 Oct 20;14(15):2361–70; N. Siegfried, M. Muller, J. Volmink, et al. “Male circumcision for prevention of heterosexual acquisition of HIV in men.” Cochrane Database Syst Rev. 2003;(3):CD003362; B. Auvert, D. Taljaard, E. Lagarde, J. Sobngwi-Tambekou, R. Sitta, A. Puren. “Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial.” PLoS Med. 2005 Nov;2(11):e298. Erratum in: PLoS Med. 2006 May;3(5):e298; R.C. Bailey, S. Moses, C.B. Parker, et al. “Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial.” Lancet. 2007 Feb 24;369(9562):643–56; R.H. Gray, G. Kigozi, D. Serwadda, et al. “Male circumcision for HIV prevention in men in Rakai, Uganda: a randomised trial.” Lancet. 2007 Feb 24;369(9562):657–66; S.M. Bertozzi, T.E. Martz, P. Piot. “The evolving HIV/AIDS response and the urgent tasks ahead.” Health Affairs. 2009 Nov–Dec;28(6):1578–90.

  86. 86.

    ”Voluntary Medical Male Circumcision for HIV Prevention - An Interview with Emmanuel Njeuhmeli. Posted October 26, 2016” by PLOS Collections. http://blogs.plos.org/collections/vmmc-2016-interview/. Accessed 27 February 2017.

  87. 87.

    B. Auvert, D. Taljaard, E. Lagarde, J. Sobngwi-Tambekou, R. Sitta, A. Puren. “Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial.” PLoS Med 2005;2:e298–e298; R. C. Bailey, S. Moses, C. B. Parker, et al. “Male circumcision for HIV prevention in young men in Kisumu, Kenya: a randomised controlled trial.” Lancet 2007;369:643–656; S. Rerks-Ngarm, P. Pitisuttithum, S. Nitayaphan, et al. “Vaccination with ALVAC and AIDSVAX to prevent HIV-1 infection in Thailand.” New England Journal of Medicine 2009;361:2209–2220; Q. Abdool Karim, S.S. Abdool Karim, J.A. Frohlich, et al. “Effectiveness and safety of tenofovir gel, an antiretroviral microbicide, for the prevention of HIV infection in women.” Science 2010;329:1168–1174.

  88. 88.

    Bureau for Global Health, “The ABCs of HIV Prevention,” Washington, D.C.; U.S. Agency for International Development, August 2003. Accessed at http://info.worldbank.org/etools/docs/library/166065/Uganda-ABC%20Model.pdf.

  89. 89.

    Hearst N, Chen S. “Condom promotion for AIDS prevention in the developing world: is it working?” Stud Fam Plann. 2004 Mar;35(1):39–47; Malcolm Potts, Daniel T. Halperin, Douglas Kirby, Ann Swidler, Elliot Marseille, Jeffrey D. Klausner, Norman Hearst, Richard G. Wamai, James G. Kahn, and Julia Walsh, “Reassessing HIV Prevention,” Science 9 May 2008: 749–750; Paul R. “Tailoring AIDS Prevention,” Science 19 September 2008: 1631.

  90. 90.

    Lindsay Knight. UNAIDS: the first 10 years, 1996–2006, New York: Joint United Nations Programme on HIV/AIDS (UNAIDS), 2008, 213.

  91. 91.

    Ibid, 216.

  92. 92.

    Bertozzi SM, Martz TE, Piot P. “The evolving HIV/AIDS response and the urgent tasks ahead.” Health Affairs. 2009 Nov–Dec;28(6):1578–90.

  93. 93.

    Robert M. Grant et al. “Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men,” New England Journal of Medicine 2010; 363:2587–599.

  94. 94.

    Nelson L. Michael, “Oral Preexposure Prophylaxis for HIV—Another Arrow in the Quiver?” New England Journal of Medicine 2010; 363:2663–2665.

  95. 95.

    WHO, “WHO issues first guidance on use of antiretrovirals by HIV-negative people at high risk to prevent infection,” Geneva: WHO, July 20, 2012. Accessed http://www.who.int/mediacentre/news/notes/2012/hiv_medication_prep_20120720/en/.

  96. 96.

    Ibid.

  97. 97.

    Nelson L. Michael, “Oral Preexposure Prophylaxis for HIV—Another Arrow in the Quiver?” New England Journal of Medicine 2010; 363:2663–2665; S. M. Bertozzi, T.E. Martz, P. Piot. “The evolving HIV/AIDS response and the urgent tasks ahead.” Health Affairs. 2009 Nov–Dec;28(6):1578–90.

  98. 98.

    WHO Media Center.” WHO issues first guidance on use of antiretrovirals by HIV-negative people at high risk to prevent infection.” Geneva: World Health Organization, July 20, 2012.

  99. 99.

    PreExposure Prophylaxis for the Prevention of HIV Infection in the United States, US Public Health Service 2014 http://www.cdc.gov/hiv/pdf/PrEPguidelines2014.pdf.

  100. 100.

    “Oral Pre-Exposure Prophylaxis, Putting a new choice in context,” Geneva: UNAIDS, 2015; WHO Expands Recommendation on oral pre-exposure prophylaxis of HIV infection (PrEP). Policy Brief. WHO, November 2015 http://www.who.int/hiv/pub/prep/policy-brief-prep-2015/en/.

  101. 101.

    D Margolis et al., “Long-acting intramuscular cabotegravir and rilpivirine in adults with HIV-1 infection (LATTE-2): 96-week results of a randomised, open-label, phase 2b, non-inferiority trial,” The Lancet (2017).

  102. 102.

    J Cohen, “Breakthrough of the year HIV Treatment as Prevention,” Science 23 December 2011:334(6063):1628.

  103. 103.

    M Cohen et al., “Prevention of HIV Infection with Early Antiretroviral Therapy,” New England Journal of Medicine 2011; 365:493–505.

  104. 104.

    HIV Prevention Trial Network Press Release, May 12 2011.

  105. 105.

    Montaner, Julio SG, et al. “The case for expanding access to highly active antiretroviral therapy to curb the growth of the HIV epidemic,” The Lancet 368.9534 (2006): 531.

  106. 106.

    UNAIDS Programme Coordinating Board. Thirty-seventh meeting, Agenda Item 4. UNAIDS Unified Budget, Results and Accountability Framework 2016–2021. October 20, 2015 http://www.unaids.org/sites/default/files/media_asset/20151103_UNAIDS_UBRAF_PCB37_15-19_EN.pdf.

  107. 107.

    UNAIDS 2011–2015 Strategy. Getting to Zero. Geneva: UNAIDS http://www.unaids.org/sites/default/files/sub_landing/files/JC2034_UNAIDS_Strategy_en.pdf.

  108. 108.

    65th Session of United Nations General Assembly, Resolution 65/277, July 8 2001.

  109. 109.

    On the Fast-Track to An AIDS-Free Generation. UNAIDS and PEPFAR. 2016.

  110. 110.

    On the Fast Track to end AIDS. UNAIDS 2016–2021 Strategy http://www.unaids.org/sites/default/files/media_asset/20151027_UNAIDS_PCB37_15_18_EN_rev1.pdf.

  111. 111.

    Political Declaration on HIV and AIDS: On the Fast-Track to Accelerate the Fight against HIV and to End the AIDS Epidemic by 2030. A/RES/70/266. 8 June 2016.

  112. 112.

    Prevention GAP report. UNAIDS 2016. http://www.unaids.org/sites/default/files/media_asset/2016-prevention-gap-report_en.pdf.

  113. 113.

    Ibid.

  114. 114.

    Michel Sidibe. “Charting a path to end the AIDS epidemic.” Bulletin of the World Health Organization 2016;94:408. doi:http://dx.doi.org/10.2471/BLT.16.176875.

  115. 115.

    Ending AIDS: Progress Towards the 90-90-90 Targets. UNAIDS 2017 http://www.unaids.org/sites/default/files/media_asset/Global_AIDS_update_2017_en.pdf.

  116. 116.

    Ibid.

  117. 117.

    Ending AIDS: Progress Towards the 90-90-90 Targets. UNAIDS 2017 http://www.unaids.org/sites/default/files/media_asset/Global_AIDS_update_2017_en.pdf

  118. 118.

    Ibid., See also “The Gap Report” Geneva: Joint United Nations Programme on HIV/AIDS (UNAIDS), July 2014 UNAIDS / JC2656.

  119. 119.

    Ending AIDS: Progress Towards the 90-90-90 Targets. UNAIDS 2017 http://www.unaids.org/sites/default/files/media_asset/Global_AIDS_update_2017_en.pdf.

  120. 120.

    PEPFAR Latest Global Results. 2016. Accessed on May 4, 2017 at https://www.pepfar.gov/documents/organization/264882.pdf

  121. 121.

    Kim, Sung-Hee et al. “Adherence to Antiretroviral Therapy in Adolescents Living with HIV: Systematic Review and Meta-Analysis.” AIDS (London, England) 28.13 (2014): 1945–1956. PMC. Web. 8 Aug. 2016.

  122. 122.

    The TenoRes Study Group, “Global epidemiology of drug resistance after failure of WHO recommended first-line regimens for adult HIV-1 infection: a multicentre retrospective cohort study.” The Lancet Infectious Diseases, 2016, 16(5):565–575, http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(15)00536-8/abstract.

  123. 123.

    Sarah Boseley, “Hope for the “end of AIDS” is disappearing experts warn,” The Guardian, 31 July 2016.

  124. 124.

    Ending AIDS: Progress Towards the 90-90-90 Targets. UNAIDS 2017 http://www.unaids.org/sites/default/files/media_asset/Global_AIDS_update_2017_en.pdf.

  125. 125.

    UNAIDS Programme Coordinating Board. Thirty-seventh meeting, Agenda Item 4. UNAIDS Unified Budget, Results and Accountability Framework 2016-2021. October 20, 2015 http://www.unaids.org/sites/default/files/media_asset/20151103_UNAIDS_UBRAF_PCB37_15-19_EN.pdf.

  126. 126.

    Lisa Carty. Interview by Michael Merson, Durham, NC, October 8, 2012.

  127. 127.

    Devi Sridhar, Danielle Kuczynski, and Kristie Latulippe “Background Report for UNAIDS Transition Working Group.” New York and Oxford UK: Center for Global Development/Global Economic Governance Programme, 2008. Used with permission.

  128. 128.

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    See Appendix 5 and 6

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  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: Finding its Place in Congested Waters. In: The AIDS Pandemic. Springer, Cham. https://doi.org/10.1007/978-3-319-47133-4_18

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