UNAIDS, the UN, myths & conspiracies: where next?

UNAIDS, the Joint UN Programme on HIV/AIDS, has experienced declining funding since 2015.  Big reviews were undertaken in 2017 and another is scheduled to deliver in June 2025.  This excellent article by Richard Parker in March 2024 sets out many of the complexities the Programme and the wider response to HIV faces, speaking to the multiple “meanings and interpretations that the response to the pandemic has produced”.

UNAIDS Secretariat undertook restructuring between 2021-2023 which with hindsight could be considered superficial.  It did not obviously take into account the capacities of the wider Joint Programme which were assessed as ‘mission critical’ in 2022.  In 2025, with all the top five funders of UNAIDS likely to cut back funding [most catastrophically, the USA on 27 February], the crisis it finds itself in is dramatic and existential.  The Programme, oft vaunted for its success but also with a fair set of challenges, can be seen as a microcosm of the UN.

UNAIDS plight was not completely unforeseen.  But it is not the time to point fingers, nor lament as the turmoil around USAID swirls, more to assure ourselves that the services and advocacy for those people living with and affected by HIV are maintained as best as possible.  This is not easy with diminished capacity and multiple priorities – particularly for employees of UNAIDS Cosponsors and the Secretariat, member states and NGOs involved with the Joint Programme, many of whom have been juggling more and more diverse and integrated portfolios for years.

One such ‘overlap’ can be seen with UNAIDS and WHO, the latter being more of a punching bag.  Unfortunately many people – particularly those leaning towards or harbouring conspiracy theories – don’t tend to appreciate nuances and challenges associated with multilateralism (e.g. WHO is both an independent agency and a UNAIDS Cosponsor).  This is illustrated by damned-if-you-do and damned-if-you-don’t situations that a public health approach and managing limited budgets entail.  For example, based on having incomplete information, an organization/government might produce too many vaccines as a precaution and be criticized for incompetence/waste/corruption; or produce too few when a disease turns out to be more lethal than expected and be criticized for being incompetent/lax/unprepared.

An outstanding public health result, remarkable considering the despair and apparently intractable nature of the HIV epidemic a quarter of a century ago, is the availability of antiretroviral therapy (ART).  UNAIDS and particularly WHO have had a major contribution to ensure three-quarters of people living with HIV receive ART today, which when taken correctly and consistently enormously increases life expectancy as well as making the virus untransmissable.  

However, stigma, discrimination, and lack of education about HIV/AIDS remain substantial.  ‘Key populations’ - men who have sex with men, transgender people, sex workers and people who use drugs – are more vulnerable to contracting HIV.  Their behaviour is criminalized in many countries.  Consequently, they may be unable or reluctant to seek life-saving prevention and treatment.

Around 40% of funding for HIV/AIDS in lower- and middle-income countries comes from international donors.  The risks of slipping back into a situation where the virus may resurge loom large in the ‘great’ age we find ourselves in.

In my experience the vast majority of people working in the UN, multilateral system, NGOs and civil society are dedicated, pragmatic and creative.  Many are suffering a lot now.  They are not saints but hard-working and decent people worried about job security and the future of their families, and perhaps having the hope that one day that the narrative will switch and Eirene might prevail over Polemos.

I worked for five organizations in UNAIDS from 2005-2024 and write in a personal capacity