Opinion With the decision to wind up UNAIDS by next year, the 2030 global AIDS-free target looks increasingly fragile
Five years before the target to end AIDS, the UN’s move risks collapsing a system that once transformed global health
It is strange logic to wind up a highly successful joint UN programme when the global target is only five years away, and to do so without openly and transparently sharing the reasons for such a radical decision with civil society, especially the communities who have a direct stake in continuing global efforts. 
By J V R Prasada Rao
The “sunsetting” or winding up of UNAIDS, the Joint UN Programme on AIDS, by 2026 as recommended by the UN80, has come as a bolt from the blue. This development follows a trend that began with WHO, which had to radically curtail its establishment, and was further compounded by the winding up of USAID’s AIDS efforts and the reduction of funding for the President’s Emergency Plan for AIDS Relief (PEPFAR), both of which adversely affected AIDS treatment programmes. However, the decision to wind up UNAIDS entirely and merge it with WHO is far more consequential. It will have a far-reaching impact on global efforts to end AIDS by 2030.
Since the time it was established in 1994/5, UNAIDS had successfully accelerated all-round efforts to combat the AIDS pandemic. Apart from being the global advocate for important decisions in the United Nations General Assembly Special Session in 2000 and subsequent events, UNAIDS became the rallying point for communities disproportionately impacted by HIV. Countries across the globe followed the global body’s soft diplomacy to create space for communities to form and sustain their own organisations to agitate for a strong response to prevent new infections and provide treatment to those infected. In the process, the global AIDS response became the most successful public health programme for controlling a communicable disease, prompting the UNGA to declare the end of AIDS by 2030 as a Sustainable Development Goal.
It is strange logic to wind up a highly successful joint UN programme when the global target is only five years away, and to do so without openly and transparently sharing the reasons for such a radical decision with civil society, especially the communities who have a direct stake in continuing global efforts. As a result, there is considerable confusion among community representatives about what will follow after 2026 and how their aspirations will be met. This uncertainty is further compounded by scepticism about the capacity of an already weakened WHO to take on the new mandate in an open, inclusive, and community-responsive manner.
One other reason for the decision to wind down the programme, apart from the funding crisis, could be the organisation’s increasing irrelevance, resulting from pursuing wrong policies and priorities. The challenge of HIV and AIDS is unique because of the special position occupied by communities at risk of infection, and the organisation had long maintained a strong focus on the virus and its manifestation as a public-health challenge, avoiding diversion into related agendas. In recent years, however, UNAIDS has strayed into broader social-sector issues such as inequality and the general concerns of women and children — areas that fall squarely within the mandates of other UN bodies like UNICEF, UNFPA and UNIFEM. In the process, UNAIDS seems to have lost confidence in its ability to serve as an effective advocate for ending AIDS. As a result, it appears that not many tears will be shed within the UN system if the joint programme is wound up and handed over to WHO.
But the solution does not lie in “punishing” the organisation for its mistakes but in looking for an alternative approach that is less harmful than totally winding it up. The joint programme essentially dealt with two distinct types of issues: One relating to advocacy for preventing new infections through community participation and empowerment, and the other relating to biomedical interventions such as ART and PMTCT for providing treatment to those infected. The latter requires strong technical support and monitoring, which WHO, as a global health body, could provide. The prevention and advocacy agenda, however, needs to be handled as a highly focused activity by a smaller and fighting-fit unit housed in the office of the United Nations Secretary-General (UNSG). In the absence of UNAIDS, it is only the UNSG’s office that can instil confidence and provide space for communities to continue pressuring national governments not to take the pedal off HIV prevention programmes. We feel that no other organisation within the UN system can perform this role effectively for the next five years.
Earlier, the cliché for the global AIDS response was that it was at a crossroads. Now there are no crossroads. All the roads are closing, leading to an existentialist threat to the programme. A practical and well thought-out strategy is the need of the hour, not a donor-influenced, hasty decision.
The writer is former health secretary, Government of India, and former regional director of UNAIDS
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