It’s not much fun representing an NGO at the World Health Assembly (WHA). Professional associations like IAS are allowed “Observer status” at UN meetings. This is definitely a government gig – a little bit shocking for those of us lulled by the rather inclusive style of new AIDS approaches like the Global Fund. But the UN is all about the world’s governments. That’s not always a bad thing. Big government gatherings can have important outcomes – making resolutions and guidelines that change how governments do things for their people. And of course WHO has a vital role in setting health standards and advising Health Ministries on effective responses. But there is often a risk that those who reach the elevated state of government simply don’t know what will make a difference for the people they serve – and they are subject to the lurches of political interest and change. For AIDS and development this is often dangerous. Development takes time; AIDS can’t be solved with “quick fixes”.
This is a defining year for AIDS, 2010 is the deadline established by the international community to achieve universal access to HIV prevention, treatment and care for all those in need. Sadly the WHA planners hardly seemed to notice that this is a special year for AIDS, but then this is nothing new. AIDS rarely makes it on to the agenda of the WHA, so the only way anyone could speak about AIDS was to intervene (if allowed) in the debate on the Millennium Development Goals (MDGs). And for a civil society “Observer” that meant jumping through a large number of tedious bureaucratic hoops.
WHO produced a very clear background paper that acknowledged that there has been progress on AIDS and that we are still some distance from the Universal Access target. A nice resolution was tabled stating that we all need to do more on all the health MDGs with a couple of mentions of doing more on AIDS – but that was about it. Yet this is the year that we should hold each other accountable for achieving Universal Access. Sadly most countries - especially powerful donor countries - seem to have shifted their attention to maternal health (and sometimes child health). Who cares if the AIDS job is not yet done? It’s politically boring, so time to find something new.
It is beyond doubt that the increased focus on maternal and child health is extremely important, but why should this drain political and financial support from AIDS? Research has demonstrated the inextricable link between AIDS and maternal and child health. AIDS remains the leading cause of death of women of reproductive age globally, and HIV is a major cause of maternal death in hyper endemic countries. Maternal & child health and AIDS are not competing health needs, to regard them as such, is a zero sum game approach to global health. Often it is the same family: the woman with HIV who risks dying in child birth because she is sick and not on treatment is the same woman whose child gets infected and dies because there is no decent PMTCT service. Simply stated, meaningful gains in maternal and child health cannot be achieved without strong and consistent efforts to reduce the global spread and impact of HIV and AIDS.
The IAS has had Observer Status at the WHA for some time and given the significance of 2010 for AIDS, we decided to use this Observer Status to demand that the Health Ministers of the world sit up and take notice of what has and has not happened on AIDS – and more importantly how much more we have to do. We also called for the development of a new WHO AIDS Strategy 2011-2015. This should be straightforward, but with so little political interest in AIDS, there was a real risk that WHO would be blocked from moving forward and developing a new strategy, (this would not be smart – especially not when they have a brand new Director of their HIV Department – Gottfried Hirnschall, who is determined to set WHO back on course to do the right thing on AIDS)... There are 2 ways to get your message across at the WHA: one is to make grand statements to the meeting; the other is to corner far more powerful people over coffee. Fortunately we did both. If we’d relied on the power statement we would have been very frustrated. A colleague who runs another global health group was particularly fed up: he waited from 10 am to 9pm to give his 3 minute intervention. I felt quite smug that I had only been hanging around for 7 hours... But eventually we all got to speak – very briefly – and I hope that what we said had some impact. At the end of the day it looked as if – with the wise leadership of Brazil and Thailand – there was going to be agreement to move forward and WHO would be encouraged to produce a new AIDS strategy.
The only wrinkle is that the US intervened and changed the language Brazil had proposed to direct WHO to write their new strategy. Wherever the resolution talked about “harm reduction” the US diplomat asked for this to be re-phrased as "comprehensive prevention and treatment programmes for injecting drug users". Sounds good enough? But below the surface it’s a clear signal: avoiding the term “harm reduction” means avoiding any implicit acceptance of decriminalisation or safe injecting facilities – and weakens what we are all willing to do. After two days of wise arm twisting and a stellar intervention from the progressive Norwegians, the US agreed that the language could be changed back to “harm reduction.” Small victory you may think, but for global policy advocates it is an assurance that the Obama administration is heading towards the right track.
We are relieved that the resolution passed, and that the WHA made the right decision, with the right language in its resolutions. It’s important because in most countries Health Ministries listen hard to WHO. So it matters if they talk about AIDS (or not) and that they develop a new AIDS strategy. That is why we have pledged the support of the IAS to help them keep the momentum going, and we will keep on waiting to give our speeches and to press our messages at future WHAs. We hope to work closely with WHO as they take this forward, including organizing a consultation with IAS members and WHO at Vienna to inform the direction of WHA’s new AIDS strategy, which thankfully they are now allowed to develop.