Global HIV/AIDS: Five Leadership Issues

UNAIDS Executive Director and Under Secretary General of UNAIDS, Peter Piot addresses the launch of the AIDS Epidemic Update conference at the Parliament house annexe in New Delhi. (Photo: RAVEENDRAN/AFP/Getty Images)

The 2008 World AIDS Day focused on leadership issues. The focus on leadership is very appropriate as the future looks uncertain regarding a continued global resolve to contain the defining health challenge of our time. The change of guard at UNAIDS with the departure of the long term chief, Peter Piot, is a case in point. The continuing global financial crisis calls into question the capacity of G-8 nations and other Western countries to increase or maintain their level of support for AIDS remedial efforts in poor countries. The capacity of resource-challenged and AIDS-hard hit nations to mobilize national support is also compromised by continued food crises and growing rates of poverty. Despite notable success in the global fight against HIV/AIDS, 7,500 individuals contract HIV every day and at least 6,000 people die of AIDS every day.

Although the fight against AIDS recorded an unprecedented thirty-fold increase in funding during the last decade, the UNAIDS estimates a current funding shortfall of US$10 billion a year to effectively fight the pandemic. As noted by the United Nations Secretary General, Ban Ki-moon during the 2008 World AIDS Day, although 3 million people are on antiretroviral therapy, individuals become infected at a faster rate than they can get into treatment. At least 6 million individuals worldwide that qualify for treatment are not on antiretroviral therapy. The fate of these millions of people unable to have access to treatment is grim.

The global fight against HIV/AIDS requires strong leadership on five critical issues. I briefly discuss these leadership issues.

1. Need for Strong, Focused UNAIDS.

In an earlier article (The Future of UNAIDS), I had discussed the need for a comprehensive reorganization of the UN agency coordinating the response to HIV/AIDS. To become focused and play its role as the lead technical and advocacy leader in the fight against the global epidemic, Michel Sidibe and new leadership of UNAIDS will have to deal with the need for a consolidated UN system-wide program on HIV/AIDS; the need for new partners in the fight against the pandemic; the need for community-based response to the pandemic; and, the need to create viable platforms and structured opportunities for the youth and individuals living with HIV/AIDS to participate in the fight against the pandemic.

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2. Strengthen the Global Alliance against HIV/AIDS.

One of the biggest challenges ahead is how to maintain, grow and strengthen the global alliance against HIV/AIDS. This global alliance, although loosely structured, achieved unprecedented success in the face of overwhelming odds. The global alliance played a critical role in the exponential rise in AIDS funding. They also played a critical role in improving access to life saving medicines. The alliance was the vanguard of the fight to ameliorate stigma and discrimination against individuals living with or affected by HIV/AIDS. The alliance helped prod reluctant politicians and policy makers to intervene against the epidemic in their countries. In Western countries, the alliance played immeasurable roles in prodding policy makers to provide financial and technical support to poorer countries with high rates of infection. Unfortunately, the global alliance is showing sign of fraying as gaps in access to treatment widens, preventive programs falter and funding streams, stagnates. Strengthening the global alliance against HIV/AIDS will require new mobilization targets with particular emphasis on access to treatment, recruitment of new stakeholders, and, showing evidence of progress on the ground in AIDS hard-hit countries. The UNAIDS, the Global Fund to fight AIDS, Tuberculosis and Malaria, and, the United States President’s Emergency Plan for AIDS Relief will be critical prime movers in revitalizing and strengthening the global AIDS alliance. Governments of China, Brazil, India and the rich Gulf states are important new stakeholders in view of the ongoing global financial turmoil.

3. Plan and implement national HIV/AIDS programs at community levels.

For nearly two decades, the focus of international HIV/AIDS remedial efforts has been to strengthen national response mechanisms. This effort has largely been successful as most countries in the world now have national programs on HIV/AIDS. However, HIV transmission occurs at individual levels and the response against AIDS manifestations occur at family and community levels. It is now time to move the fight against HIV/AIDS to family and community levels. This effort will require strengthening community-based health systems, recognizing and solving barriers to timely access to health services, and, dealing with social and economic issues that negatively impact preventive and treatment programs.

4. Mainstream HIV/AIDS programs into regular health and development programs.

To guard against “donor” and “supporter” fatigue against AIDS programs, it is now critical to integrate HIV/AIDS programs with other health and development programs. The mainstreaming of HIV/AIDS programs is also necessary because of the well known health and development consequences of the pandemic. The mainstreaming of HIV/AIDS program should start at the highest levels of executive and legislative decision making of national governments. It should also be a part of the highest level decision making in the private sector as they develop health and development strategies. The civil society should also promote mainstreaming of HIV/AIDS in their interactions with policy makers at the national, regional and local levels of government. At the program level, decision makers should focus on verifiable evidence of integrated HIV/AIDS, health and development programs for specific target populations and communities. The global effort to promote universal access to HIV/AIDS, Tuberculosis and Malaria in resource-challenged environment is a good template for mainstreaming HIV/AIDS into regular health and development programs. The UN Millennium Development Goals is another example.

5. Strengthen basic and clinical collaborative research.

It is no secret that research on HIV vaccine has recorded false starts and setbacks. It is also no secret that research on possible “cure” for the disease has stalled. However as noted by one of the foremost HIV researchers, Tony Fauci of the US National Institutes of Health in his address at the 2008 AIDS Conference in Mexico, progress continues to be made on the structural components of HIV and how these components assist HIV to interact with multiple host factors in the cells of infected individuals. Tony Fauci in his presentation also discussed intense research efforts to understand the ‘window of vulnerability’ with HIV that offers a ‘window of opportunity’ for possible clinical intervention as the virus invades the body, disseminates and seeds in the tissues of the body, and establishes a latent component phase of the disease. In plain English, scientists now know enough of how HIV infects humans that they are working on how to prevent HIV from becoming established in the human body. Translating this knowledge into viable clinical interventions will still take years of research. Leadership is very critical in providing funding for promising research, creating laboratories and research centers in AIDS hard-hit countries, establishing and sustaining research collaboration between academic centers in rich and poor countries, and funding the pipeline of young, talented researchers. A largely unexplored strategy is the role of Diaspora scientists from poor countries trained in Western institutions and working in the West. These Diaspora scientists, most of whom started their scientific careers in their home countries, can become important research ambassadors in organized efforts to strengthen research capacities in resource-challenged environments. With necessary incentives and cooperation from native country governments, Diaspora scientists can become critical in research efforts against HIV in Africa, Latin America, the Caribbean and South East Asia.


The fight against the HIV/AIDS pandemic has been ongoing for at least two decades. Significant strides have been made, especially in the last ten years, with more funding available and more individuals on life saving medicines. However, the future looks uncertain as the global financial crisis bites. The scenario of more than six million people unable to access lifesaving medicines, and 7,500 people infected with HIV everyday despite widespread preventive programs, is unsettling. The 2008 World AIDS Day appropriately focused on leadership. The future of the global fight against HIV/AIDS will depend on strong leadership at all levels. In this article, I discussed five important global leadership issues in the fight against HIV/AIDS.

Selected Reference Materials for this Article

1. United Nations Secretary General (2008). The Secretary-General Remarks on World AIDS Day. Doha, 1 December 2008. Available at

2. Peter Piot (2008). Message on the Occasion of World AIDS Day. I December 2008. Executive Director of UNAIDS. Available at

3. Margaret Chan (2008). Message for World AIDS Day. WHO Director-General. Available at

4. Elizabeth Mataka (2008). World AIDS Day Statement by the Special Envoy of the Secretary-General for AIDS in Africa. Available at

5. UN News Service (2008). On World AIDS Day, UN Officials Call for Continued Momentum to Tackle Disease. Available at

6. The World Bank (2008). Fight Not Over on 20th Anniversary of World AIDS Day. December 1, 2008. Available at

7. (2008). XVII International AIDS Conference. Looking to the Future – The Epidemic in 2031 and New Directions in AIDS Research. August 6, 2008. Available at

8. Chinua Akukwe (2008). The Future of UNAIDS. Available at

9. UNAIDS (2008). UNAIDS. The First 10 Years. Available at

10. UNAIDS (2008). Report on the Global AIDS Epidemic. Available at