By Paul Theerman, Associate Director

The WHO Special Programme on AIDS was the first response of the United Nations to the pandemic that had gained world attention by the mid-1980s.¹ The offspring of the first two international conferences on AIDS, in Atlanta in 1985 and in Paris the following year, the Programme was founded in February 1987. The Programme’s dynamic director, Jonathan M. Mann, had great hopes and grand plans for combating AIDS through a coordinated worldwide response—the only feasible way to control the virulent and widely spreading disease, he thought. From the beginning he also saw the AIDS outbreak as a focus for engaging global human rights issues. Under Mann, the WHO moved beyond its role of technical advisor to national governments, for it tried to take a directive role, actively engage non-governmental organizations, and promote non-discriminatory policies towards AIDS sufferers. Between 1987 and 1989, the Special Programme—which also came to be known as the Global Programme on AIDS—developed a comprehensive strategy for attacking the virus.

These two posters—one design in two languages—come from the heady days of the Programme’s beginning. Produced in 1987, these posters announced its slogan, “AIDS: A worldwide effort will stop it.” The posters’ design inadvertently reveals how difficult it was to talk about AIDS in the 1980s. AIDS seemed different from other diseases. First of all, it was a pandemic experienced in the west, perhaps the first such experience since the polio epidemic in the early 1950s, and before that, the influenza pandemic in 1918–19. With the rise of antibiotics and vaccination, widespread disease outbreaks in the developed world were no longer supposed to happen! As Dr. Gerald Friedland, a doctor on the front lines during the height of the pandemic, said at an event at Columbia University earlier this month, the disease caused the “inverse of the life cycle,” as it mostly impacted young people, leading to parents burying their children. “The only thing comparable was war.”

With AIDS, neither antibiotics nor vaccination worked, so epidemiologists were forced back to classic means of halting pandemics: stopping the means of transmission. Here also AIDS proved difficult. Those means—chiefly sexual contact and sharing needles—provoked strong reactions. Coupled with a long latency and an invariably fatal outcome after a horrific decline, AIDS did not have a simple profile.

The posters display that cultural unease. The UN commissioned noted New York graphic designer Milton Glaser, an internationally known logo and poster designer, with such readily recognizable designs as “I ♡ NY,” Esquire and New York magazines, and Sony, among many others. Certainly Glaser knows about the power of images to convey meaning. For these UN posters, he combined three elements, two hearts and a skull, to make a W—presumably to stand for “world” in the World Health Organization, and to reference the caption, “A worldwide effort will stop [AIDS].” But it’s not clear—and it doesn’t work in the Spanish version of the poster. Even more puzzling is the relationship of the hearts to the skulls. Is it cautionary: in the midst of love—erotic love, that is—lurks death? Is it hopeful: compassionate hearts will combine to crush AIDS? Is it both? Glaser produced a striking image, but he also produced an ambiguous one. By 1991, the red ribbon had been introduced as the predominant AIDS symbol, and it soon the supplanted the “heart-and-skull-W,” even at the UN itself.

The year that this poster came out proved to be the Programme’s high point. In 1988 a new director-general came to the World Health Organization. AIDS could not have two masters. By late 1989, the Programme’s efforts, strategies, and budget were brought up short, and Mann departed in 1990. The Programme limped along for another five years, until replaced by UNAIDS, the locus for United Nations action today. In the words of Mann’s successor,  Michael H. Merson: the Programme “was unable to muster the necessary political will . . . , and its effectiveness was compromised by . . . an increasing preference of wealthy governments for bilateral aid programs.”² That seems where matters stand now, as we approach World AIDS Day, December 1. The story of the Special Programme on AIDS is a cautionary tale of the difficulties of grappling with a worldwide disease in a disjointed world.

References

1. Much of the history of the Special Programme on AIDS is found in two article by its founding director: Jonathan M. Mann, “The World Health Organization’s global strategy for the prevention and control of AIDS,” in AIDS—A Global Perspective [Special issue] Western Journal of Medicine 1987 Dec; 147:732–734; and Jonathan M. Mann and Kathleen Kay, “Confronting the pandemic: the World Health Organization’s Global Programme on AIDS, 1986–1989,” AIDS 1991; 5 (suppl. 2): S221–S229.

2.  Michael H. Merson, “The HIV–AIDS pandemic at 25—the global response,” New England Journal of Medicine 2006; 354:2414–2417 (June 8, 2006), quotation from page 2415.