Expert Says UN HIV, AIDS Program Ineffective

The exclusive focus on HIV promoted by the Joint United Nations Programme on HIV/AIDS (UNAIDS) is damaging health systems and distorting health financing, and UNAIDS should be closed down immediately, writes an expert in this week's BMJ.

We are spending far too much on HIV relative to other health needs, writes Roger England, Chairman of the Health Systems Network. Some of the money would be better spent on strengthening general health services and funding more effective interventions in other diseases such as pneumonia and diabetes that kill more people, he adds.

Globally HIV causes 3.7% of mortality, yet receives 25% of health aid and a big proportion of domestic expenditure.

But HIV has not been the global catastrophe that was predicted, he says, in fact global HIV deaths are about the same as deaths of under fives in India.

"With its own UN agency, HIV has been treated like an economic sector rather than a disease," claims England.

Billions of pounds have been wasted by national AIDS commissions and in funding obscure disciplines and projects instead of strengthening public health systems in developing countries that could have controlled transmission, he argues.

In addition, excessive HIV aid has created parallel financing, employment and organisational structures that have weakened national health systems and sidelined much needed structural reform, he says. Furthermore, off-budget HIV-dedicated funding provides no incentives for sustainable country systems, achieves poor value for money, and increases aid dependency.

He believes that only 10% of the US$10bn a year dedicated to HIV is needed for the 2 million people now receiving free treatment. Switching the rest of the HIV funding to general health budgets would make a huge difference to developing country health systems allowing them to prioritise and improve the way they deal with prevention and treatment of a range of diseases.

A UN agency dedicated to a single disease is a liability, and UNAIDS needs to be closed down, concludes England: "not because it has performed badly given its mandate - but because its mandate was wrong and harmful. Its technical functions should be re-fitted into WHO, to be balanced with those of other diseases."