Urgent tasks await new head of UNAids

Earlier this week it was reported that five people are still in the running for the Joint United Nations Programme on HIV/AIDS (UNAids) top job. They are South African Professor Salim Abdool Karim, Winnie Byanyima, Professor Chris Beyrer, Dr Bernard Haufiku, and Dr Sani Aliyu.

The appointment of a new executive director comes at a difficult time for UNAids. In December 2018 an independent inquiry was deeply critical of leadership at the UN agency, and particularly of the way in which allegations of sexual harassment were handled. As a result, the previous head of UNAids, Michel Sidibé, had to step down. Currently, Gunilla Carlsson is acting in the role.

Questions have also increasingly been asked about whether we still need a UN agency focused on HIV and AIDS. Spotlight previously reported on alleged covert plans to collapse the agency into the World Health Organisation (WHO). Whatever may have become of those plans, real questions should be asked about what role UNAids should play in future, if any. The answer to this should then inform the choice of the executive director, UNAids’ third one (excluding the acting executive director). Professor Peter Piot was the first UNAids executive director, followed by Sidibé.

At a most fundamental level, UNAids should be an internationalist entity aimed at ensuring HIV is eliminated as a public health threat as soon as possible. This implies a role in coordination, fund-raising and diplomacy, but maybe most fundamentally in the framing of the global AIDS response.

One of the biggest blunders of the Sidibé years was the premature rhetoric about the “end of AIDS” – at a time when even UNAids’ own modelling suggested we were not nearly on a trajectory to end AIDS by 2030. It seems plausible that the over-optimistic rhetoric contributed to a sense of complacency and a general perception that HIV no longer requires urgent action. The “end of AIDS” rhetoric was eventually scaled down, but not before significant damage was done.

One of the most important tasks for the new UNAids executive director would be to reframe the discourse on AIDS. This does not mean we need new spin – it means that we need a new sense of realism and seriousness. It means building a new narrative around AIDS that is firmly rooted in scientific evidence, human rights, and common decency and understanding. This will require an executive director who knows and understands both the dynamics of the epidemic and that of the AIDS community.

At the 2018 international AIDS conference in Amsterdam, much was said about what it would take to reinvigorate AIDS activism, something most seem to agree is needed. One lesson from the global AIDS response around the turn of the century is that doctors, researchers, lawyers and policymakers were all part of the AIDS movement. UNAids itself started as a uniquely activist UN agency – but the urgency and animation has waned. For UNAids to justify its continued existence, as opposed to being collapsed into the WHO, it has to again become an activist agency.

Ideally, the new UNAids executive director will be someone who can bring the urgency and shared sense of activism back to the HIV response. While it is easy for candidates to say they will do this – actually doing it is another matter. While the head of UNAids has to be politically astute, he or she also has to be willing to step on toes when needed and to once again make HIV and AIDS a political crisis (it never stopped being a humanitarian crisis).

The new executive director would also have to address the very serious leadership and organisational culture problems identified in the inquiry into how allegations of sexual harassment were handled at the agency. UNAids needs to ensure that all its employees can safely report sexual harassment and have their allegations properly and fairly investigated by people who are independent and impartial. Given the links between gender-based violence and HIV, UNAids should be setting an example in this regard.

We are not in a position to definitively say which of the five candidates best meet the above criteria – and being based in South Africa we obviously know Karim better than we know the other candidates. That said, we have asked experts and members of the AIDS community from around the world about their views on the five candidates. We have by no means conducted a scientific survey, but we have at least some sense of sentiment in the AIDS community. With those caveats out of the way, here are some observations on the five candidates:

Winnie Byanyima, an aeronautical engineer, diplomat, freedom fighter and human rights activist, heads Oxfam and worked previously with the UN Development Programme. She is the only woman on the short-list. She handled sexual harassment allegations at Oxfam much better than Sidibé did at UNAids. She has no high-level experience in HIV, and is not that well-known in the AIDS world, especially among researchers and scientists. She could potentially be a hard sell to some in the AIDS world, but is a popular choice among activists who feel she is just the person for the job – and in the current atmosphere that makes her a front-runner alongside Karim.

Professor Salim Abdool Karim is internationally recognised to be a leading HIV researcher and clearly knows the epidemic and the HIV community well. Less well known is the role he played in strengthening and dramatically increasing funding for the South African Medical Research Council when he headed it from 2012 to 2014. Karim’s work has not focused specifically on human rights, but much
of the research conducted at CAPRISA, the research organisation he
heads in KwaZulu-Natal, is aimed at finding ways to help young women
stay HIV negative. He was also an outspoken voice during the
government’s denialist era. Based on the various conversations we’ve
had, he seems to be one of the front-runners for the position.

Professor Chris Beyrer comes with an excellent HIV pedigree, having previously headed up the International AIDS Society and he has both a strong biomedical and human rights background. He is a professor of epidemiology and like Karim, he knows and understands the HIV epidemic and AIDS community very well. Beyrer is openly gay, well-liked among most people we spoke to – but fairly or unfairly (unfairly in our view) it will probably count against him that he is North American (he was born in Switzerland to American parents, but grew up in the US). Had it not been for that, his chances would have been very good.

Dr Bernard Haufiku, a medical doctor, is a former minister of health and social services of Namibia. He is currently the health adviser to Namibia’s deputy president. He does not have the international HIV experience and profile that Karim and Beyrer have, but is well-spoken of by those who know him. They specifically mention his record in promoting human rights. He is viewed as someone who understands the need for a community-led response to HIV. His lack of experience on an international platform makes him an outsider for the position.

Dr Sani Aliyu, a medical doctor and microbiologist, is the director-general of Nigeria’s National Agency for the Control of AIDS (NACA). There are estimated to be about 1.9-million people living with HIV in Nigeria. The epidemic is most prevalent among women in Nigeria. Like Bernard Haufiku, he is an outsider for the UNAids top job given his relative lack of international HIV experience and his limited profile in the AIDS world. DM