Friday, 29 April 2005

Dear Peter,

I noted your statement in today's Kaiser AIDS Daily summary* that, when asked about the role of UNAIDS in coordinating all AIDS-related efforts within the U.N. system so that global HIV/AIDS organizations "have one song sheet. We all sing one song, and it's not so easy to do that," and that you consider yourself "the conductor of the orchestra of all the AIDS efforts."

At this week's STAC-HIV meeting (the WHO Strategic and Technical Advisory Group for HIV) it was sadly apparent that at times and in many places this orchestra is sadly out of key, and that the singers are not always singing from the same score.

Many examples came up of poor coordination between UNAIDS and UN family partners, particularly WHO, at the global and country levels.

For example, recent statements by you have had the effect of signaling retreat by the UN system on its support for harm reduction as a scientifically validated public health method of reducing HIV transmission risk among injecting drug users.

Recent statements by UNAIDS, for example at the "Making the Money Work" meeting in London on March 9, have resulted in confusion about what exactly the fiscal needs are for HIV/AIDS control over the next five years.

Finally, UNAIDS collaboration with WHO on 3x5 at country level has been uneven.

For example, while in Cambodia it seems that partnership is effective (as a joint presentation by the WHO and UNAIDS country officers indicated) in other countries it has led to confusion and delay, for example in Nepal where UNAIDS and WHO appear to have quarreled over the responsibility for acquiring a CD4 testing machine, thereby delaying its purchase under a global fund grant and delaying the start-up of the ARV program there.

I am writing to request that you send a strong signal to UNAIDS staff at every level to work more closely, harmoniously, and effectively with WHO staff engaged in HIV and TB/HIV activities, that UNAIDS more effectively coordinate the activites of other UN partners in supporting the scale-up activities associated with 3x5, and that you support the WHO in developing sound, comprehensive, evidence-based fiscal estimates to support full funding of the HIV/AIDS prevention, care, and treatment scale-up package at the replenishment conferences, at the G8, at the Millennium GA meeting, and in the next five years.

Finally, I ask you to put UNAIDS firmly and unequivocally on record in support of sound science-based prevention interventions including harm-reduction.

Yours,

Mark Harrington
Executive Director
Treatment Action Group

* [Apr 29, 2005]: UNAIDS Executive Director Peter Piot on Thursday in an interview on C-SPAN's "Washington Journal" … said he is in Washington, D.C., to discuss with incoming World Bank President Paul Wolfowitz and incoming UNICEF Executive Director Ann Veneman their organizations' leadership roles with HIV/AIDS programs in developing countries. When asked about the role of UNAIDS in fighting HIV/AIDS, Piot said that the agency coordinates all AIDS-related efforts within the U.N. system so that global HIV/AIDS organizations "have one song sheet. We all sing one song, and it's not so easy to do that." Piot said that as executive director, he is "the conductor of the orchestra of all the AIDS efforts" and has worked during his tenure to place HIV/AIDS on the political agenda of wealthy countries. He also said he has redefined AIDS as "not just a medical curiosity but as an obstacle to social and economic development … and also a threat to security and stability," and he works to make sure there is continued funding for countries affected by HIV/AIDS. According to Piot, about $200 million was spent on HIV/AIDS in developing countries when UNAIDS was founded seven years ago, compared with approximately $6 billion last year. "Our job is really to make that money work and make sure that all the players are working in the same direction," Piot said.

Response from Peter Piot, 5 May 2005:

From: Peter Piot, UNAIDS
To: Mark Harrington, TAG
Date: Thu, 5 May 2005

Dear Mark,

Thanks for your note. As always, I am very grateful to you for sharing your concerns, but I must confess that I find some of them perplexing and must take issue with them.

First, let me make this absolutely clear – the UNAIDS Secretariat has been a strong and vigorous supporter of 3 by 5 since its inception – and indeed of WHO's leadership on HIV treatment within the UNAIDS' family of Cosponsors. This support is both at headquarters where we have provided Secretariat members to the 3x5 team in WHO, and more importantly in countries, where the UNAIDS Secretariat has worked with WHO and national authorities to ensure that treatment is secured firmly at the centre of comprehensive national AIDS strategies. Well over a year ago, I have instructed staff to do so, and they are requested to regularly report back on their support for 3x5.

Is everything perfect and harmonious? Definitely not! Do individual staff always put the fight against AIDS before institutional turf? Unfortunately not … and you're right that collaboration on AIDS (in general, not just on 3x5) has been uneven. That's why we have been investing so much energy in the "Three Ones" to maximize our collective effectiveness, particularly since funding for AIDS is still largely insufficient. That's also why we're working hard with our colleagues from UNAIDS Cosponsors WHO, UNICEF, UNDP,the World Bank, and from the Global Fund and many others on the Global Task Team on harmonization of AIDS efforts.

I hope we'll come up with some practical proposals to move the agenda, but at the end of the day these will have to be translated by each organization into some institutional behaviour change …

I wonder which recent statement you're referring to that makes you conclude that the UNAIDS is "retreating" on its support for harm reduction. I made our position clear in a pannel I chaired at the UN Commission on Narcotics and Drugs in Vienna, and have no problem confirming UNAIDS' long standing position in support of harm reduction as part of a comprehensive approach to HIV and injecting drug use – before any other multilateral organization, and before many governments that allow harm reduction today …

In general it would be useful to have specific global and country evidence on the problems you mention, as we can then take action.

All the best,

Peter