As a UN high-level panel completes worldwide consultations to pick development goals for 2015 and beyond, PlusNews consulted experts to see how HIV/AIDS might fit into this new agenda.
The UN Secretary General’s Special Envoy for AIDS in Asia and the Pacific, Prasada Rao, told IRIN countries have generally done well on Millennium Development Goal (MDG) 6, which seeks to stop new HIV infections by 2015.
Twenty-two of the 33 countries that have seen a drop in HIV incidences from 2001-2010 are in sub-Saharan Africa, the hardest-hit region. New HIV infections have been halved from their levels a decade ago, but the goal needs to be carried forward, said Rao. “We can’t just drop it here. We need to go the full length.”
When the MDG goals were presented in 2000 - along with a 2015 deadline to meet them - the idea of an AIDS-free world invited incredulity, said the envoy. But prevention and treatment gains in recent years changed perceptions, he added. “It is no longer [just] an aspiration, but an achievable [goal]… The time has come when we really need to look at this concept of ending AIDS and how to position it in the post-2015 agenda.”
Since August 2012, the UN has held 83 national consultations on creating goals for 2015-2030. For health-related goals, a draft report has been prepared for the 27-member high-level panel. The draft is based on months of moderated debates, web-based consultations, e-surveys, e-discussions and face-to-face meetings with civil society groups, governments, researchers as well as more than 100 position papers.
Focus moving away from HIV?
The 28 February draft includes calls for HIV to be among the new goals, but also suggestions to move beyond disease-specific goals (an “overly narrow, target-driven approach” according to the UK NGO Health Poverty Action) to address health equity, non-communicable disease and weak health systems.
During the consultations, there were already signs that HIV might lose attention, the International Council of AIDS Service Organizations (ICASO) wrote in a December 2012 release: “There are rumblings that the post-2015 health agenda will focus on cancer, diabetes, heart disease and other less politicized afflictions. HIV is no longer seen as a crisis; ironically the AIDS response is being dealt a blow by its own success.”
ICASO, along with Stop AIDS Alliance and International Civil Society Support, hosted an online survey, webinars and a January meeting in Amsterdam for HIV, tuberculosis and malaria advocates.
The health draft report currently reads: “Pulling back from these goals now would waste the profitable investments made to date. Ending preventable child and maternal deaths, and ending the epidemics of HIV, tuberculosis and malaria should be reaffirmed as global priorities.”
The Bill & Melinda Gates Foundation has cautioned against “an overarching health goal that covers such a long list of issues that is it impossible to set any priority” while Stop AIDS Alliance called for “approaches that place human rights and equity at the centre [and] move away from the top-down thinking that characterized the MDGs”.
At a meeting on health in the post-2015 agenda, held in Botswana earlier this month, participants lauded gains facilitated by MDGs - increased funding and attention to global health, for one - but also noted how these goals led to “fragmented approaches to development”.
For Asia’s AIDS envoy, Rao, goals have to be demystified to attract supporters, including parliamentarians, to fight HIV. “Otherwise, it looks very exotic. What do you mean by an AIDS-free generation? One of the [slogans] we used at UNAIDS was ‘End AIDS’, but what do you mean by ‘End AIDS’? You need to translate that into clearly actionable strategies and programmes. What needs to be done in the next 10 years to end AIDS?”
For him, those steps are: reduce new HIV infections to negligible levels, with elimination targets; provide antiretroviral (ARV) treatment to at least 80 percent of those who need it; and change laws, or their enforcement, that have blocked access to HIV prevention and treatment services.
One target of MDG 6 is to provide ARVs to all in need by 2010; this target is still unmet. According to the 2012 MDG Progress Report, from 2008-2010, about 1.3 million new people were enrolled and retained on ARVs. At this rate, less than 14 million people will be receiving treatment at the end of 2015, over one million short of the 15 million target, the report calculated.
The post-2015 panel is expected to present its recommendations to the UN Secretary-General this June.