26 Jun 2019

Yes, we really do need UNAIDS

As the global network of people living with a disease that still infects 1.8 million people every year and kills another 1 million annually, GNP+ can say loud and clear: Yes, we absolutely need UNAIDS as a distinct body that leads and co-ordinates the HIV response.

And not only do we still need UNAIDS, this is the time we need it to be stronger than ever to send a clear message globally that the AIDS epidemic is not over.

Yes, we have had tremendous success in scaling up treatment. However, only 21.6 million of the 36.9 million people living with HIV globally are accessing treatment. That is less than two-thirds of people who need treatment for their own health and to prevent further transmission of HIV.  Reaching the remaining 15.8 million will not be achieved by doing more of the same. The 41% of people living with HIV who do not have access to life-saving treatment now are the ones harder to reach – key populations living with HIV, the most disadvantaged rural and urban populations, the most disempowered financially and the most vulnerable because of gender inequalities. In some parts of the world and for some communities we are going backwards. We also have a crisis in HIV prevention, with 5 000 people being infected every day, especially among adolescent girls and young women as well as key populations. It is extremely dangerous to assume that a bend in the curve means mission accomplished.

More than ever we need a strong UNAIDS to transform the response to the epidemic – a transformation that is not about scaling up by doing the usual.

Responding to HIV is not about a stand-alone disease – the HIV response empowers communities, promotes gender equality and human rights, addresses social and structural barriers, and builds stronger and more accountable systems of health. This is also why UNAIDS is the first and only joint and cosponsored UN programme to combine the special expertise, resources and networks of various agencies. Our work on HIV has often catalyzed changes in the health systems and opened doors that have never been opened before. While mobilizing domestic political agendas on HIV, UNAIDS have often mobilized agendas on other areas, particularly on human rights, health systems strengthening, and most importantly on democratic rights. And it has been doing so in the most effective way: by ensuring that all these political agenda mobilizations can be measured by concrete and tangible sets of indicators – such as decrease in incidence and death related to AIDS. Ending AIDS remains a priority within the Sustainable Development Goals (SDGs) and an effective HIV response will help the world make progress not only on SDG3 on health, but beyond on gender equality, poverty, education, partnerships, strong communities and many others.

We must remember how critical UNAIDS is at national and regional levels as well. At the country level, UNAIDS has relatively successfully mobilized political support on the disease. We need UNAIDS at country level to convene and coordinate a robust HIV response, speak up for and support the meaningful engagement of communities living with and affected by HIV (including those from key populations), support the development of inclusive and integrated national health strategies, advocate for bold national AIDS plans that mobilizes all sectors and addresses structural barriers and ensure adequate investment in priority areas based on what works.

Also, as regional political structures become more important, we need UNAIDS to be influential at these levels. While guidelines and targets may be set at global level, the regional groupings (be it the African Union or BRICS) are critical to ensure greater political momentum in countries.

While it is still unclear how the global health architecture will continue to evolve and where it will end (or whether it will ever), one clear thing that we can learn from the past is that it is important to have a clear distinction between global institutions that develop science-based normative guidance, those who finance the implementation of those normative guidance, and the one that can mobilize global political commitments based on data and building a unified multi-stakeholder movement to ensure that the HIV agenda is rooted in the reality of our community. The World Health Oganization, UNAIDS and Global Fund are essential combinations that will ensure that not only the global HIV response goes well, but create necessary changes at the level where it is desperately needed: on the ground.

Perhaps one day we will not need UNAIDS. In fact, that would be the success of the AIDS response. But we are far from being at that point. HIV is still a global emergency. And we need a strong UNAIDS to lead all of us in a global, regional and national response to end AIDS.

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