Commentary on Accountability by the WAC

none 29 nov 2006 – 13:12 (modified on 30 nov 2006 – 17:46)

by mlepeska

Efforts to halt AIDS are falling far short of their targets. Over 25 million people have been lost to AIDS so far, and 4.3 million people were infected with HIV this year. The spread of HIV is quickening – with more people infected in 2006 than in any previous year. This is despite the number of promises by world leaders to provide services to curb the rates of infection and to bring down deaths.

At the United Nations General Assembly Special Session on HIV/AIDS in June 2001, heads of state and government committed themselves to meeting a number of key goals to fight AIDS.

By 2005, 90 percent of young people were supposed to know how to prevent AIDS. In reality only 20 percent of young women and 30 percent of young men had this knowledge.

By 2005, 80 percent of pregnant women living with HIV were supposed to be receiving the simple treatment that can prevent their children from contracting the virus. This treatment costs just a few dollars, yet only 9 percent received it.

In other high level meetings, governments of rich countries promised to increase the spending on development aid to 0.7 percent of their annual budget. Only a handful of countries have done so. In Africa, leaders committed to allocating 15 percent of their budgets to health. This has happened in just one or two countries, with only a third of African countries spending over 10 percent.

Promises are not being kept because there is a staggering lack of leadership at every level.

Promises are not being kept because AIDS is now a multi-billion dollar industry with hundreds of committees and working groups at national and international levels which rarely challenge the status quo or ask hard questions about results.

Global targets on AIDS prevention, treatment and care have been stripped away and replaced by national targets. National targets are the most meaningful, yet this means that the donors and agencies facilitating the international process can no longer be held to account, and campaigners and activists are finding it increasingly difficult to engage. Meanwhile at the national level, civil society is often not given the opportunity or the resources to scrutinise what is going on.

Internationally, donor countries and multilateral agencies are failing to work together. Instead, they compete with their own different initiatives. Nationally governments are failing to speak out consistently on AIDS and failing to work with the most vulnerable groups – sex workers, men who have sex with men, injecting drug users, and prisoners. And at every level, civil society has dispersed into myriad interest groups on different AIDS themes while losing sight of the bigger picture.

The division of civil society has in part been driven by competition for funding. Professional groups often dominate the AIDS agenda, while large, constituency-based networks, such as labour and youth groups, find it hard to organise and be heard in this competitive environment. The civil society contribution to the AIDS response is increasingly a money-driven operation – losing the voluntarism and passion that once fuelled their efforts.

Many serious thinkers now question whether the infrastructure set up at great expense to combat AIDS is fit for purpose. The UN and multilateral agencies designated to drive the response are particularly under scrutiny. Yet many, including the World AIDS Campaign, have resolved to continue to work in partnership with these agencies, hoping that constructive criticism and public scrutiny will turn them back towards the efforts needed to halt the epidemic.

The biggest test of the current paradigm is captured in the global effort to provide as close as possible to universal access to treatment, prevention, care and support by 2010.

This goal, first adopted for Africa in the 2005 G8 summit and then later expanded worldwide at the UN High Level Meeting on AIDS in 2006, involves countries setting national targets for universal access which are ambitious yet realistic. So far the process has not inspired much reason for confidence. Only around half of the countries have set targets and fewer have done so with proper consultation with groups outside of government.

The danger is that donors, the UN and national AIDS authorities have embarked on a course of action that is not open to effective questioning or scrutiny. The international voices that once spoke out on the need to meet global targets are effectively silenced. Four years from now we could be looking at an even more dismal scorecard in the fight for AIDS and asking how we allowed this to happen.

All of us reading this should be asking how we make sure this does not occur, and what we can do to ensure they Keep the Promise. The rights, wellbeing and survival of millions is at stake.

By Thomas Scalway

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