In (partial) defence of UNAIDS

Writing in The Guardian, Siddharth Dube takes aim at UNAIDS and other UN organisations for failing the people most at risk for HIV. (Bringing UNAids to Book) Speaking of UNAIDS and other organisations such as the Global Fund to Fight AIDS Tuberculosis and Malaria, Dube says:

“we have created these organizations, given them clear mandates, and funded them very well; what we have failed to do so far is to scrutinize their work in ways that would make them live up to their full potential.”

The second part of this statement is surely true. The first, however, is not. UNAIDS was set up in 1995 to try to stop a bunch of existing UN organisations from scratching one another’s eyes out over what was then a very small amount of money (the world spent under US$ 300 million on AIDS in the developing world in 1995 — the total now is close to US$ 10 billion). It did not have a clear mandate; it was supposed to do nothing more than “co-ordinate” the activities of the other agenices, each of which had its own mandate. Many of those mandates has little to do with helping the people most at risk for AIDS, and some were positively inimicable to effective prevention. Worse, some of the mandates were at odds with one another — that’s how we ended up with the “AIDS is a development problem not a health problem” diversion.

Hoping that an amorphous “joint programme” could sort out the mess was a bit like sending a UN peace-keeping force into an area where there was no peace to keep, and on top of that ensuring that the troops came from the former colonial powers that undermined security in the area in the first place.

Let’s remember, too, that each of the UN organisations is itself governed by member states, who are simultaneously board members, shareholders and executives. Those states are naturally loathe to criticise themselves for anything much, and so the institutions can’t do much criticising either. In the case of AIDS we can’t expect UNAIDS or WHO to scream blue murder about the willful neglect of an eminently preventable disease by the majority of governments in East and Southern Africa; those governments make up an important voting bloc in the UN as well as within the specialised agencies.

UNAIDS may be profligate, inefficient and poorly managed. But the real fault lies in the way we have structured the United Nations, a fault compounded in the case of UNAIDS precisely because it does not have a clear mandate.

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This post was published on 18/12/07 in Money and AIDS.

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