Southern African health ministers have warned that disruptive changes to the United Nations HIV programme could put progress against AIDS at risk, while calling for reform that preserves its data, advocacy and technical support.
The ministers and officials responsible for HIV and AIDS made their appeal during a regional meeting in Durban, South Africa. Their position, set out on 13 November, backs continued work by the Joint United Nations Programme on HIV/AIDS, known as UNAIDS, as governments face pressure to sustain health services and finance their responses.
The warning is not a rejection of reform itself. Ministers want changes to retain the expertise and country support used to guide policy and measure progress. They cautioned that ending the programme or disrupting its functions could weaken coordination and accountability, particularly in a region heavily affected by HIV.
The appeal follows a decision by the UNAIDS Programme Coordinating Board in October to support a continued but more streamlined joint programme. The board rejected an approach that would have wound it down. That decision settled the broad direction towards retaining the programme, but the details of the transition still need to be worked through.
What ministers want protected
The regional ministers identified strategic information and analysis as central functions. Data about the epidemic helps countries identify gaps, assess progress and decide where to direct resources. The appeal also covers political advocacy, coordination and technical advice for governments developing their HIV policies.
South Africa’s deputy health minister, Joe Phaahla, called for sustained domestic investment alongside international cooperation. He argued that the gains made through political leadership, scientific progress, community mobilisation and cooperation should not be placed at risk by uncertainty or declining resources.
Ministers also emphasised human rights and the role of communities in shaping the response. Their priorities include access to HIV prevention and treatment, stronger health systems and partnerships involving governments, civil society and international organisations.
Those are objectives and warnings about possible consequences, not a finding that a particular reform has already caused services to fail. Ending AIDS as a public health threat by 2030 remains the shared target; the ministers’ concern is that an ill-managed transition could make that goal harder to reach.
The reform already under way
At its special session on 26 October, the coordinating board approved the overall strategic direction for a transition. It backed a focused secretariat, or hub, with co-sponsoring organisations taking stronger leadership in technical areas. The programme brings together 11 organisations across the UN system.
The envisaged hub is to concentrate on leadership and advocacy, convening and coordination, accountability and data, and support for communities. The proposed division of work would put more technical and programme implementation responsibilities with the co-sponsors, which include health and development organisations.
The board also backed a phased transition shaped by countries’ circumstances and readiness, with communities involved at every level. It asked for a transition team with secretariat and co-sponsor representatives and two community representatives. The team is to consult stakeholders and produce a fully costed implementation plan for which it will be accountable to the board.
Questions remain about how long the transition should take and how the programme’s presence in individual countries will be organised. The decision to retain a joint programme therefore does not, on its own, settle how every function will be delivered or funded in future.
Wider regional pressures
The Durban gathering brought together health ministers and ministers responsible for HIV and AIDS from the Southern African Development Community. Technical and ministerial engagements took place from 9 to 12 November, with the ministerial meeting formally opened on 12 November.
Alongside HIV, the discussions covered tuberculosis, malaria, health emergencies and the financing of essential services. Ministers considered how countries could strengthen health systems and improve access to medicines as development assistance comes under pressure and competition for resources increases.
During the meeting, Tanzania became the first member state to sign a charter for a regional pooled medicines procurement body. The signing is a step towards a joint purchasing mechanism, rather than confirmation that the full system is already operating.
For the HIV response, the ministers’ appeal places the focus on continuity during change: maintaining the information, expertise and community partnerships that countries use while the joint programme’s future structure is developed.
