A critical time for UNAIDS

I attended the UNAIDS Board meeting from 24-26 June, representing Frontline AIDS on the NGO delegation. At a uniquely challenging time, the Programme Coordinating Board (PCB) raised critical questions regarding the future of the global HIV response, and UNAIDS’ role within it. Also joining these discussions was Amrita Sarkar, Advisor on Transgender Wellbeing and Advocacy at Alliance India, who has just been appointed as NGO delegate for Asia.   

Joint Programme Operating Model

This PCB follows a report by a High-Level Panel, which recommended significant revisions to UNAIDS’ operating model, making it leaner and focused on four core functions: leadership, convening, accountability, and community engagement. The NGO delegation were concerned that rights and inequalities were not explicitly included. Raising our concerns, we secured a board decision, ‘requesting that actions to address inequalities are integrated across these four priorities’, and received assurances from UNAIDS Executive Director Winnie Byanyima that human rights remains a core part of UNAIDS’ mandate.  

The Panel also recommended that UNAIDS downsize and following the withdrawal of US funding UNAIDS has laid off 55% of staff, closed 31 country offices and reduced the number of co-sponsoring agencies, as well as cutting co-sponsors’ funding. These rapid changes risk leaving a vacuum in leadership for ending AIDS. As civil society, we must be proactive in ensuring that key gaps are filled.  

Disappointingly, the Panel did not address the challenges facing the Middle East and North Africa, which has had no UNAIDS presence since 2023 and has a rapidly growing HIV epidemic. However, it did propose an enhanced role for communities and civil society in the new operating model, including as members of new Joint Teams on AIDS which will be set up at  national and regional levels.  These could be important spaces for advocacy and partnerships, and could potentially provide a specific vehicle to increase leadership in the MENA region. 

A new Global AIDS Strategy

Frontline AIDS partners have been shaping the next Global AIDS Strategy for the period 2026-2030. With HIV services and community-led organisations in crisis, they have emphasised the need to increase priority given to HIV prevention at national level; to adopt systems that are centred on key and vulnerable populations; and to ensure that communities are recognised and funded as essential service providers.

These areas are well reflected in the draft strategy outline presented at this PCB, which prioritises sustaining HIV services, including prevention, addressing inequalities, and powering community leadership. Partners’ asks around strengthening domestic resource mobilisation and integration of HIV into health systems, as well as humanitarian and climate change responses, are also well addressed.

However, while including these key commitments, the outline lacked a clear sense of the acute crisis facing the HIV response at present, and the strategy will require further strengthening to really capture the need for urgent, focussed and courageous action. In addition, while the outline includes a dedicated priority on ‘equity, dignity and access’, marking an important step towards placing human rights on an equal footing with other areas, the use of the word ‘dignity‘ reflects a wider tendency to avoid talking explicitly about issues that might be controversial for more conservative stakeholders. These include health and human rights for transgender people’s rights, as well as harm reduction, both important aspects of a rights and evidence-based HIV response.

More broadly, Frontline AIDS partners called on UNAIDS to place countering anti-rights movements and disinformation at the forefront of our global approach but clear commitments were missing, and the loss of dedicated targets on gender equality is also concerning. Addressing these gaps must be a key priority in the next stages of the strategy development process.   

The future of UNAIDS

The High-Level Panel proposed that the Joint Programme prepare to ‘sunset’ in 2030 and some have suggested that this timeline may be moved forward. This is due to financial difficulties facing UNAIDS and the UN80 process, which is expected to propose that some UN agencies merge. Intervening, I warned PCB members that “it would be both financially unwise and extremely unrealistic to disband UNAIDS at this point in our history, when all that we’ve worked for and invested in is in danger”. I argued that “our energy should be focussed on showing why UNAIDS is still needed, highlighting what’s at stake, and working together to find smart, innovative and decolonised ways to fund the vital work that faces us in the next five years”.   

Ending AIDS among children and adolescents

Whilst challenging, this PCB did bring important advances.  In a follow up to a thematic meeting on children and adolescents in December, our advocacy secured PCB decisions urging countries to scale up youth-led service delivery models, to strengthen participation of youth-led organisations in financial and programming decisions, to remove policy and legal barriers and to strengthen the provision of comprehensive sexuality education. The recognition of youth-led organisations is a first in the PCB and follows a powerful presentation by Tumie Komanyane on Frontline AIDS’ youth-led READY model, as well as excellent engagement by partners Y+ Global and Paediatric AIDS Treatment for Africa (PATA) to shape the thematic. 

What’s next? 

With the Global AIDS Strategy to be presented for adoption at the 57th PCB in December, critical work is needed to influence the strategy content and engage PCB delegates on priority areas.  I look forward to working with my co-delegate Amrita Sarkar to ensure that Frontline AIDS partners continue to be heard in strategy discussions.  A thematic on long-acting antiretrovirals in December offers further opportunities for our partnership to engage in PCB advocacy, building on our leadership on HIV prevention. 

Conversations I had at this PCB also made me reflect on how unusual UNAIDS is, in having formal mechanisms to engage people living with and affected by HIV and reminded me that we need to be heard in discussions happening outside the HIV space, particularly the UN80 process. We must push for the meaningful involvement of people and communities living with HIV; for community-led civil society organisations to be part of those discussions, to safeguard all that we value in UNAIDS; and to sustain global leadership for ending AIDS into the future.