UNAIDS Report of the UNAIDS Leadership Transition Working Group UNAIDS Leadership Transition Working Group Chairs Members Program Coordinator Ruth Levine Joanne Csete Danielle Kuczynski Ngaire Woods Siddharth Dube Tim Evans Senior Researcher Jacob Gayle Devi Sridhar Geeta Rao Gupta Jim Kim Michael Merson Lillian Mworeko Nandini Oomman Nana Poku Asia Russell Todd Summers Alan Whiteside Anandi Yuvaraj Th is report was draft ed by Ruth Levine, Ngaire Woods, Danielle Kuczynski and Devi Sridhar, with the input of working group members. Members of the working group participated in a personal capacity and on a voluntary basis. Th e report refl ects a broad consensus among the members as individuals, though not all members necessarily agree with every word in the report. Th is text does not necessarily represent, and should not be portrayed as representing, the views of any single working group member, the organizations with which the working group members are affi liated, Oxford University, the Global Economic Governance Programme or its funders, the Center for Global Development, or the Center’s funders and board of directors. Copyright ©2009 by the Center for Global Development ISBN 978-1-933286-37-2 Center for Global Development 1776 Massachusetts Avenue, NW Washington, D.C. 20036 Tel: 202 416 0700 Web: www.cgdev.org Support for this project was generously provided by the Bill & Melinda Gates Foundation as part of the HIV/AIDS Monitor Program of the Center for Global Development Cover photo: UN Photo/Mark Garten Editing and typesetting by Communications Development Incorporated, Washington, D.C. Table of contents Preface iv Acknowledgments v Summary 1 About this report 4 Box 1 What is UNAIDS? 4 Evolution of the AIDS epidemic and UNAIDS 7 Continuing an exceptional response: Key roles for UNAIDS 11 Recommendations for the Secretariat’s Executive Director and the Board 14 Figure 1 Organizational structure of UNAIDS in Geneva 22 Moving forward 23 Annex A Working group biographies 24 Annex B Participants in background interviews 30 Annex C Summary of consultations for UNAIDS working group and participants 32 Annex D Methodology 38 Annex E Further reading 40 References 44 UNAIDS: PREPARING FOR THE FUTURE i Preface When leaders change, so can institutions. At the and bring a diversity of perspectives—from Center for Global Development we have taken those focused on protecting human rights to the opportunity of leadership change at major those engaged in the intricacies of UN reform, global institutions to ask questions about their from epidemiologists concerned about the in- mandates, resources, and governance and to pro- tegrity of health data to civic activists who see pose (or not) changes and reforms. Our series the global response to HIV/AIDS as too slow has included the World Bank (June 2005), the and too limited. Given the breadth of stakehold- InterAmerican Development Bank (January ers involved directly and indirectly in the work 2006), the African Development Bank (August of UNAIDS, members tried hard to recognize 2006), and the Global Fund to Fight AIDS, a range of points of view, both from members of Tuberculosis and Malaria (October 2006). the working group as well as from participants Now, with the departure of Dr. Peter Piot as at three consultations. Executive Director of the Joint United Nations I am hopeful that the recommendations in Programme on HIV/AIDS (UNAIDS), Ruth this report help UNAIDS consolidate the suc- Levine, who leads our global health policy pro- cesses of the past decade and focus squarely on gram, has collaborated with Ngaire Woods, areas in which it has unique and needed con- Professor of International Political Economy tributions to make in the future: giving voice and Director of University College for Oxford to the voiceless, pushing for a more eff ective University’s Global Economic Governance Pro- response within the UN system, building and gramme, to lead a distinguished working group disseminating evidence for better policies and asking how that unique body should evolve to programs, and bolstering the capacity for action meet future needs. at the country level. Th ose of us on the outside In the course of this project the working will be watching with interest. group members found how deeply held the views about UNAIDS are and how expansive Nancy Birdsall the hopes for its contributions in the future. Its President defenders and challengers alike are passionate Center for Global Development ii UNAIDS: PREPARING FOR THE FUTURE Acknowledgments Many individuals helped to shape this report. paper. We would also like to thank Nancy Bird- First, we would like to thank the members of sall for her thoughtful comments on the report the UNAIDS Leadership Transition Work- and Lawrence MacDonald, John Osterman, ing Group, who gave their time, intellect, and and the communications team for their ideas patience over the months that it took to pull and ongoing support. the report together. Th eir expertise and sharp Th e success of the second consultation is observations brought clarity, humanity, and owed to the team at the Global Economic Gov- depth to the fi nal recommendations. We thank ernance Programme, particularly Reija Fanous them for their invaluable contributions. and Edward Joy. Th is meeting provided a great Th e report draws on a series of interviews turning point for the project, helping to focus and global consultations (see annexes B and C the discussion that emerged from the Washing- for lists). We thank the interviewees we con- ton consultation. sulted throughout this project who provided Particular thanks go to the team at the unique insights into the workings of UNAIDS. Health and Economics Research Division We would also like to thank the participants in (HEARD) at the University of KwaZulu-Natal the three global consultations held in Washing- in Durban, South Africa, and Alan Whiteside ton, D.C., Oxford, and Durban. Th e partici- for hosting our third consultation. Th is meeting pants at these meetings provided valuable and refl ected a valuable country-level perspective. broad-reaching insights and ideas that spanned Special thanks go to Andy Gibbs at HEARD— from Capitol Hill to the front lines of the pan- Andy’s careful collaboration from the start of demic in sub-Saharan Africa. We hope that the the project and work in pulling together the diverse views presented are refl ected in this fi nal consultation were invaluable. product. Th e content of this report signifi cantly ben- We also thank the team at the Center for efi ted from a review by Lindsay Knight, whose Global Development for their contributions. expertise with UNAIDS introduced extra pre- Acknowledgment goes to Heather Haines for cision and refi nement. her assistance with the Washington consulta- Finally, we would like to thank Todd Sum- tion and Kristie Latulippe for her substantial mers for intellectual contributions and the eff orts in planning the fi rst consultation and for Bill & Melinda Gates Foundation for the grant her intellectual contributions to the background that facilitated this work. UNAIDS: PREPARING FOR THE FUTURE iii Summary Established in 1996, the Joint United Nations Programme on HIV/AIDS (UNAIDS) brings several United Nations agencies together around a joint man- date to lead, strengthen, and support an expanded and multisectoral response to the AIDS epidemic. With many accomplishments to its credit, informed by academic research, interviews, and UNAIDS stands as a unique example of a consultations in Washington, D.C., Oxford, cosponsored UN body. It has been a visible and Durban. player over the past decade, as the AIDS epi- Sparked by the question do we need demic has achieved global prominence as a UNAIDS?, the working group agreed that there political and social cause. Since its inception, are important reasons for UNAIDS to con- UNAIDS has been led by its founding Execu- tinue. First, the nature of HIV/AIDS—its rela- tive Director, Dr. Peter Piot, with whom the tionship to issues of human rights and political program became closely identifi ed. With his marginalization and its profound and multisec- departure in December 2008 and the selec- toral determinants and consequences—calls tion of Michel Sidibé as his successor comes for a response above and beyond many past an opportunity to refl ect on both the strengths responses to health conditions. Second, the and shortcomings of UNAIDS. In the United commitments at national and global levels States and elsewhere calls for expanded com- to support the response to HIV and AIDS mitments to global health—with an Institute must be fulfi lled, and UNAIDS is uniquely of Medicine committee recently recommend- positioned—as a special part of the United ing that the United States increase offi cial Nations—to ensure this. Th ird, given its en- development assistance for global health to gagement with both UN member states and $15 billion over four years1—and the prolif- civil society, UNAIDS can promote preven- eration of actors working on HIV and AIDS tion, care, and treatment approaches based on make this a particularly timely moment to both scientifi c evidence and respect for human question the role of UNAIDS in responding rights. to the pandemic. While the rationale for UNAIDS is strong, The UNAIDS Leadership Transition working group members and many of those Working Group was convened in July 2008 by who contributed ideas and information to the the Center for Global Development and Oxford working group process see signifi cant room University’s Global Economic Governance Pro- for strengthening the program. Th e working gramme as an independent ad hoc panel with group believes that, to be most eff ective, the the mandate to formulate a set of recommen- core mission of UNAIDS should be to use its dations for the next executive director and the status and strategic connections as a UN en- governing Programme Coordinating Board of tity to press governments to uphold their ex- UNAIDS.