The 69th World Health Assembly (WHA) next week will see all eyes on the WHO again after a turbulent couple of years. Condemned for its failings in the global response to Ebola, stuck in a process of reform that everyone agrees is needed but no-one knows how, and on the brink of declaring yellow fever a public health emergency of international concern, things are hotting up for the election of the new Director General.
Given all of these issues it is easy to overlook some of the more detailed aspects of the WHA69 agenda - the strategies and documents the assembly is set to discuss and approve. One of these strategies - buried as item 15.1 - is the Draft Strategy for HIV/AIDS 2016-2012. This strategy sets out the future of the global response to the epidemic.
Such strategies are always important as they signal the intent and commitment of the world to combat the disease. However the 2016-2021 Strategy is the most important of the last ten years.
Funding towards HIV/AIDS is in decline. The disease does not occupy global levels of attention among policy makers and practitioners as priorities and therefore money shift to pandemic preparedness in response to the 2014 Ebola outbreak. Under the new UN Sustainable Development Goals - 'the global goals' - infrastructure and sustainability are the new fashion, with HIV/AIDS included as an afterthought and relic of the 2000 Millennium Development Goals. At the national level there is a sense of complacency as states are encouraged to look to means of co-financing their HIV/AIDS support systems.
In sum, the progress seen in the HIV/AIDS response of the last 15 years could easily be unravelled without a strong strategy that can galvanise political will of the member states.
So is the 2016-2021 Strategy strong enough to do this? The good news is the strategy is pretty bold for a UN document. It is clear that the world has the know how and resources to manage HIV in a way that significantly reduces new infections and allows those living with the virus to live a healthy life. But as always, the devil is in the detail.
Everyone can agree that to end HIV/AIDS you need strong health systems including the dry but vitally important information and data systems, and the often corrupt but necessary procurement chains. However there is little guidance as to how that can happen. Just stating the need for robust health systems and listing this as a country action point is not enough: these countries need resources and the political commitment to do so.
Women and girls are mainstreamed throughout the strategy but there is no guidance on how to address gendered power structures that mean there are more females living with HIV than males. Predictably given the illegality of homosexuality and high levels of homophobia in many countries with high incidence of HIV/AIDS, LGBTQ rights are alluded to but not named or addressed as action points.
Fundamentally the Strategy outlines a lot of action points for member states to do but not much for the WHO beyond 'guidance' 'guidelines' and 'technical support.' This is standard WHO fare, but for the Strategy to be realised much greater help from the WHO and UNAIDS is warranted otherwise countries - most of which are low or middle income countries - have to manage and pay for the burden themselves.
Given the Strategy would have been through rounds of consultation to get this far, it will most likely be adopted by the WHO member states next week, however the UN agencies for HIV/AIDS need to do much more to see that this bold vision is realised. Otherwise it will be more of the same decline in the response that will cost millions of lives.
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