Strengthening accountability in the global response to HIV

Abstract

As the world turns its attention towards Mexico City for the XVII International AIDS Conference (AIDS 2008) the International AIDS Society and its organising partners are taking steps to use their influence at the conference to track progress on international commitments and to strengthen accountability for those commitments in key areas. The conferences and its themes have served as milestones in the global response to HIV. The theme of Access for All (AIDS 2004 Bangkok) signaled an emerging consensus that the goals established in the 2001 UN Declaration of Commitment on HIV/AIDS would not be realised without substantially greater political leadership and resources. The treatment advocacy that dominated AIDS 2004 would culminate in the 2005 commitments to universal access by 2010 made first by G8 leaders and subsequently by the international community at the UN World Summit. Time to Deliver (AIDS 2006 Toronto) reflected growing impatience with the slow pace of scaling up HIV programmes and with the resistance of governments to addressing the needs of the populations most at risk. This resistance-exemplified by the 2006 Political Declaration on HIV/AIDS which failed to mention men who have sex with men injecting drug users and sex workers-was challenged by scientific and civil society leaders at AIDS 2006 who argued forcefully that public-health imperatives must take precedence over political expediency. The AIDS 2008 theme is Universal Action Now to emphasise the urgent need to increase the pace of scale-up. It is also an important reminder that the epidemic does not exist in a vacuum-collective action to protect human rights and end stigma and discrimination in addition to rolling out biomedical interventions is required to halt the epidemic. Recent claims that HIV-targeted funding is to blame for weak health systems in poor countries ignore the fact that establishing new laboratories and clinics building stronger management systems for the supply chain and strengthening the training of health-care workers is having a broader positive effect on under-resourced health-care systems. HIV professionals have long understood the need to work in collaboration with other health advocates and to ensure that HIV programmes are integrated with other health services. In Mexico there will be many opportunities to further strengthen such alliances and to make the case that delivery of HIV programmes can catalyse other areas of the health-care system. AIDS 2008 will also be an opportunity to reflect on the June 2008 UN High-Level Meeting on AIDS. Progress reports released in advance of that meeting indicate that most countries are far off -target to reach universal access goals. At AIDS 2008 civil society and scientific leaders will join government officials to assess progress as equal partners in the response. The International AIDS Society and its partners will later issue a peer-reviewed impact report on the conference which will analyse the new science programmatic experience and lessons learned from AIDS 2008 including implications for policy and practice. Over the next 2 years the conference will also explore how as an organisation we can adopt a more targeted approach to holding stakeholders accountable. By tracking progress on a few key interventions we hope to increase the likelihood that political commitments are translated into action. (full-text)