Barack Obama election as President of the United States of America was significant, of course, because he was the USA’s first black leader. However, the awarding of the Nobel Peace Prize to President Obama ‘for his extraordinary efforts to strengthen international diplomacy and cooperation between peoples’, recognised the impact of his visionary and principled leadership. This shift in values and principles can be seen in the way the US now does business under the leadership of the US AIDS Ambassador, Dr Goosby.
At this PCB, I have had the chance to work with the US delegation, as a member of the NGO delegation rather than around harm reduction specifically. In this meeting, the key point of difference have been issues around sex workers. Current U.S. law requires organizations receiving U.S. global HIV/AIDS and anti-trafficking funds to adopt specific organization-wide positions opposing prostitution; what has been described as ‘Anti-Prostitution Loyalty Oath’. As such, the NGO delegation has clear points of difference with the US around their engagement with the sex worker agenda.
However, the culture shift is reflected in the US willingness to engage with the NGO delegation around our differences. This has helped the US to understand and engage with the wider impact of the ‘Anti-Prostitution Loyalty Oath‘ on the development and funding of the sex worker movement, which is impacting on their public health programmes. While not shifting their fundamental position, the US are trying to soften and better explain the PEPFAR regulations. One strategy has been guidance to sex worker organisations to set up separate entities to receive funding on public health agendas and legal reform work. Overnight, sex worker organisations have been debating this US position and further discussions and clarification will be sought from the US. This highlights the challenges faced by sex worker organisations but the process of engagement is none-the-less valuable and creates the potential for understanding and sensitisation of positons.
Two other global institutions have new leaders who have made public and explicit commitment to harm reduction and the human rights of key affected populations. The leadership of Michel Sidibé, as the ED of the Global Fund, and Michel Kazatchkine, as the ED of the Global Fund, provides new visionary leadership to the global battle against HIV. The ‘two Michels’ have both made impressive and principle-framing speeches. However, the challenge remains how UNAIDS, the co-sponsors and the Global Fund can configure their organisations to deliver on growing challenges of HIV prevention, treatment and care.
This session of the PCB is focussed almost exclusively on the 2nd Independent Evaluation of UNAIDS. This far reaching report challenges UNAIDS to reform its working structures, management arrangements with the co-sponsors and staffing models. Michel Sidibé is championing fundamental reform of UNAIDS with the work programme being realigned around the priority areas set out in Joint Action for Results – UNAIDS Outcome Framework (link). This is potentially helpful for the harm reduction and drug users movement given that one of the nine priorities defines how UNAIDS can ‘can protect drug users from becoming infected with HIV by making comprehensive, evidence- informed and human-rights-based interventions accessible to all drug users (i.e. harm reduction and demand reduction), including programmes to reduce hepatitis coinfection, and by ensuring that legal and policy frameworks serve HIV prevention efforts.’
There is also going to be a review of staffing levels and joint working arrangements at a regional and country level to ensure that resources are more strongly focussed at a country level. Further resources need to be aligned in light of the HIV epidemic on the grounds. This is part of a strategy described as ‘Know Your Epidemic’ which encourages countries to align their resources and responses to the nature of the epidemic on the ground. This is potential a challenge to ideologically driven HIV responses by countries hostile to the needs of particular key populations be these sex workers, men who have sex with men or people who inject drugs.
The PCB has the chance to seriously address the structural barriers that are inhibiting the effective deployment of resources and undermining joint working, particularly at country level. There is an explicit discussion about the need for ‘policy alignment’ between the UNAIDS PCB and the Boards of co-sponsors. One idea is that the Boards of co-sponsors should be requested to formally adopt and then monitor and report on progress around UNAIDS PCB decisions. Further countries are being asked to align their positions on different Boards, avoiding the current practice of countries taking different positions, for example on harm reduction, in different UN meetings.
Leaders are clearly talking and beginning to align their work and the new leaders seem committed to securing greater policy alignment between UNAIDS, the co-sponsors, the Global Fund and PEPFAR. However, the PCB has to take brave steps in creating systems that support good governance and an organisational system that can deliver on the pressing world agenda on HIV. At the same time, Michel Sidibé is also calling for an approach that doesn’t hamper the leadership role of the UNAIDS ED, allowing UNAIDS to become more responsive and nimble in addressing key issues on the ground.
This is a very technical agenda but it is clear that we have a key opportunity to bolster the effectiveness and impact of the UNAIDS Joint Programme. Securing agreement, as ever in the consensus world of the UN, will be challenging, but there does seem to be an acknowledgment that this is a key moment in UNAIDS’ history and the PCB has to step up to the plate.
Mat Southwell – Incoming Alternate for Europe on UNAIDS PCB NGO Delegation