UNAIDS - June 13, 2007

UNAIDS welcomes Ms Epstein's effort to focus attention on the global crisis of AIDS. Her book offers an account of her personal journey toward an understanding of what is required to respond effectively to AIDS. She makes a valuable contribution by highlighting the need to reduce gender inequality and sexual violence, and the different epidemiological impacts of concurrent sexual partnerships versus sequential sexual partnerships. We fully agree that AIDS is far beyond a public health issue. Moreover, effective responses to AIDS clearly necessitate changes in social norms at a considerable scale if we are to get ahead of the epidemic.

However, Ms Epstein draws a number of conclusions regarding "Africa," geopotitical causes and behavioural effects, and how national and international assistance should be designed and delivered which are presented as fact, but which have not been substantiated. Furthermore, Ms Epstein makes a number of simplifications and errors of fact and interpretation regarding AIDS responses, and regarding the work of UNAIDS, which we would like to identify and correct. Clarifying inaccuracies

-- Counter to Epstein's claims, UNAIDS has always advocated reduction of numbers of sexual partners as an effective strategy for HIV prevention*. While use of terms such as "faithfulness" are relatively recent in HIV discourse, all UNAIDS documents on the prevention of sexual transmission of HIV advocate the three established strategies of abstinence, reducing numbers of sexual partners and correct and consistent use of male and/or female condoms.

-- UNAIDS has never "pushed" condoms in preference to abstinence or partner reduction. Rather UNAIDS has worked to counter ideologically driven attacks on condom use.

-- UNAIDS addresses sex, sexuality, sexual orientation, sexual behaviour and gender in an open manner. We have engaged governments, donors, and affected communities in HIV prevention and care, and advocated for the participation and voice of key populations that are critical to the epidemic dynamics and to the response.

-- The book's assertion that the reports of independent consultants were ignored or never made public because UNAIDS disagreed with the conclusions is unfounded. When reports are commissioned by UNAIDS they are used in a variety of ways, one of which may be publications. When solid evidence is presented, it informs publications released by UNAIDS. For example, Uganda's success in partner reduction was highlighted in the June 2004 technical report** which has been on the UNAIDS website for three years.

-- Counter to Epstein's claims, UNAIDS responded quickly on the issue of male circumcision, even before trial results were known. Following the release of global policy and programming recommendations by WHO/UNAIDS Secretariat in March 2007***, WHO, UNAIDS Secretariat, UNICEF and UNFPA are now providing technical support and operational guidance at the regional and country level.

-- UNAIDS makes every effort to respond to requests for information from governments, civil society and the media. Our website is also constantly being updated and provides a wealth of information on program implementation, the status of the epidemic, the progress being made at country level, recent technologic breakthroughs, and the tools and guidelines that are now available. We welcome these queries and strongly support a free exchange of critical information.

An evolving epidemic; an evolving response

By its very nature, the AIDS epidemic continues to evolve and the response must also evolve accordingly. With 11,000 new infections and 8,000 people dying from AIDS every single day, rapid crisis-response action has been entirely necessary.

UNAIDS' response has always taken an evidence-informed approach and our policy and programmatic guidance has been adapted over time, using the best available methodology to enable us to move forward. As data have improved, we have been transparent about adjustments and revisions to our methodologies and resulting estimates. UN efforts have been critical in moving many countries out of denial and into action.

The AIDS epidemic and the response to it have always invited a high level of debate and discussion. UNAIDS provides a platform for respectful dialog among groups with differing interests, perspectives and skills. We advocate and provide rigorous analysis about the epidemic and its community, national and global context. UNAIDS welcomes debate and forward-looking feedback as this helps all of us to develop a more effective response. We know we will have to sustain the AIDS response - at increasingly high levels - for decades to come. The energy generated around the issue of AIDS must be directed at moving the response forward and working solidly together to find solutions.

UNAIDS is an innovative joint venture of the United Nations, bringing together the efforts and resources of the UNAIDS Secretariat and ten UN system organizations in the AIDS response. The Secretariat headquarters is in Geneva, Switzerlandùwith staff on the ground in more than 80 countries. Coherent action on AIDS by the UN system is coordinated in countries through UN theme groups, and joint programmes on AIDS. UNAIDS' Cosponsors include UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, ILO, UNESCO, WHO and the World Bank. Visit the UNAIDS Web site at www.unaids.org

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* For example, UNAIDS, 1997. Impact of HIV and Sexual Health Education on the Sexual Behaivour of Young People: A Review Update; UNAIDS 2000, Monitoring and Evaluation Toolkit; UNAIDS, 2004 Global Report on the Epidemic; UNAIDS/UNFPA/WHO 2004. Position Statement on Condoms and HIV Prevention, UNAIDS, 2005, Intensifying HIV Prevention. UNAIDS policy position paper; UNAIDS 2007, Practical Guidelines for Intensifying HIV Prevention.

** http://data.unaids.org/Publications/IRC-pub06/JC941-CuttingEdge_en.pdf.

*** WHO/UNAIDS 2007. New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications

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