Opportunities Lost: The UN's Failure to Fight the HIV/AIDS Cisis

By Lewis, Stephen | Harvard International Review, Spring 2008 | Go to article overview

Opportunities Lost: The UN's Failure to Fight the HIV/AIDS Cisis


Lewis, Stephen, Harvard International Review


Let me open with a simple statement of conviction: I have always believed and continue to believe that it is possible to turn the tide on AIDS in Africa. Clearly then, something is missing at the heart of the analysis to explain why remediation has not occurred. Knowledgeable activists and scientists have criticized individual African governments, lacerated the G8, raised questions about the Global Fund to Fight AIDS, Tuberculosis and Malaria and derided the US President's Emergency Plan for AIDS Relief.

But one dimension of the critique has been totally absent--the responsibility that rests with multilateralism. Had the United Nations done its job, the AIDS pandemic would by now be in retreat. There is nothing facile in that view: the United Nations has great numbers of staff, significant resources and tremendous influence in every high-prevalence country in Africa. A simple enumeration of opportunities lost gives a sense of what might have been. I shall draw upon four examples.

The first scenario involves President Thabo Mbeki of South Africa and his destructive Minister of Health, who have refused to take HIV/AIDS seriously, let alone to recognize that HIV leads to AIDS. Their staunch and irrational refusal to provide treatment has resulted in hundreds of thousands, perhaps millions, of unnecessary deaths. All the while, the United Nations has not said a word. The voices of the Secretary General, of the Executive Director of UNAIDS, and of the Directors General of WHO have remained silent, emboldening Mbeki to claim vindication for the course he had chosen.

Had the United Nations spoken out against President Mbeki's behavior, it could have shamed him into a change in policy. Failure to chastise Mbeki's ineptitude is a lasting scar on the integrity of the United Nations.

Second, there is the perplexing question of drug prices in AIDS treatment. Despite multiple meetings with brand-name pharmaceutical companies, the United Nations achieved little or nothing in terms of price reductions. Drug prices, however, did eventually decrease--so dramatically, in fact, that treatment became affordable to countless patients. And yet the orchestrator of change was not the United Nations; it was the Clinton Foundation, whose negotiations in India drastically reduced prices of generic drugs exactly equivalent in chemical composition to brand-name medications. …

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