To lead or not to lead — political power & the AIDS response

Few health issues have been as polarising or as uniting as the AIDS epidemic. Politically charged from the start, AIDS changed the way that world leaders approached health. For the first time, the world was faced with a disease that had the power to become a global security threat. That AIDS could lead to instability and economic collapse in countries and regions was sometimes acknowledged at the top with national plans; in other cases, the top was bypassed and the grass roots took the lead.

So, what does political leadership in the AIDS response involve?

1. Putting leadership into the hands of everybody.
2. Creating a powerful nexus of people, politicians and science.
3. Delivering services at scale for impact.
4. Basing the response on human rights and dignity.
5. Realising that inclusion and participation equal sustainability.

5 ways political leadership has contributed to the AIDS response so far:

1. Acting on behalf of all people through the United Nations.
2. Creating new platforms for multi-partner, long-term development success.
3. Regional sharing of economic and political responsibility.
4. Transforming monitoring, evaluation and accountability.
5. Highlighting justice issues through global advocacy.

What are the gaps and challenges we face today?

1. The AIDS response still operating in isolation
2. Fragile and insufficient health systems
3. Development challenges
4. Weak national accountability and governance structures
5. The growing complexity of the development landscape

OK, so what action should be taken in the future?

1. Develop new approaches to service delivery

The AIDS response built a global health platform that bridges community and formal systems and delivers life-long services at scale. To reach vulnerable groups and leave no one behind, HIV service delivery platforms should be strengthened through convergence with other health issues. Technology will help — but human creativity and innovation will drive the changes

2. Build new partnerships

New partnerships are needed between non-state actors, the private sector, governments and multilaterals. The public sector, civil society and the private sector must work closely together to shape policy and direction. Public–private partnerships decrease uncertainty, improve coordination, align values and goals, and facilitate mutual accountability. Public–private financial models can incentivize private investment by sharing and alleviating risks.

3. Improve people’s ability to influence the development agenda

The space for individual, community and nongovernment voices must be strengthened and expanded. The meaningful involvement of people living with, or affected by, HIV means that systems and services are more likely to evolve in ways that respond to real needs and are therefore more likely to be sustainable. By using health and HIV as an entry point, it is possible to address larger issues in society — including human rights, redistribution of opportunities, and pursuing social justice to address inequities.

4. Develop accountability for progress on the sustainable development goals

Data need to be made more widely and transparently available to people in a form that they are able to interpret and use. Information drives change, and data drive decisions and accountability. The missing piece is often the data. More than being used to point to progress and achievements, data should be used to foster dialogue within society around emerging issues, and to position and prepare the collective response.

5. Build robust, resilient health systems

The infrastructure developed for the AIDS response can be used as a platform for the expansion of other health issues. Smart integration of services provides opportunities to increase the entry points for people to access the health system. However, transformative systems for healthy people must take into account the legal, policy and regulatory environments, and the social and cultural contexts that influence access to services. It is vital to keep people at the centre while delivering quality, equitable, accessible services at scale.

Read more about political leadership in the AIDS response in UNAIDS’ new report: How AIDS changed everything — MDG 6: 15 years, 15 lesson of hope from the AIDS response

The story continues at www.whitetablegallery.org

Explore the first exhibition at The White Table Gallery which tells the story of how ‘things’ can have special meanings in the AIDS response.