UNAIDS: The First 10 Years

Chapter 7ment and health even though, in her own words, she “was not an AIDS expert”. Thus she wasable to bridge the gap between the ‘development people’ and the ‘AIDS people’, to take acool, hard look at the barriers to countries’ working effectively against AIDS and to reflect onhow UNAIDS and partners might dismantle these barriers.187Mogedal noted the huge bureaucratic burden on government officials who had to meetthe extra targets and guidelines created by the UN Millennium Development Goals andthe Poverty Reduction Strategy Papers, all complicated by the different approaches takenby donors. Some donors, for example, were much less likely to collaborate with the publicsector but preferred to work through international and national nongovernmental organizations.She also explained that the purpose of National AIDS Councils, the creation of whichhad been encouraged by UNAIDS, the World Bank and then the United Nations GeneralAssembly Special Session (UNGASS) through the Declaration of Commitments, was “verylittle understood” in many countries. There was also a tension between the Councils andministries of health: “They were somehow outside the development framework”.Sidibe worked closely with Mogedal. He explained that it was very clear that without a“consolidated, inclusive and nationally owned plan – that is, a plan owned by all the actors,not just the government – it’s impossible to make the money work for everybody. Withoutsuch a plan the money is not aligned to national priorities”.The next step was a review of the necessary steps for reaching national-level coordination ofthe AIDS response; this was conducted at the International Conference on AIDS and SexuallyTransmitted Infections in Africa in Nairobi in September 2003. Consensus was reached on aset of guiding principles to be agreed by all players involved in countries’ response to theAIDS epidemic.Initiating the “Three Ones”When the report of this consultation arrived on Piot’s desk, his reaction was: “It was prettylong and complicated and I put it aside several times, [thinking] this is one of those incomprehensiblereports which we specialize in”. After reading the report, it was clear to him thatthree principles were of key significance. There should be:one agreed HIV/AIDS action framework, a nationally devised strategic plan thatprovides the basis for coordinating the work of all partners and ensures nationalownershipone national AIDS coordinating authority (such as a National AIDS Council) with abroad-based, multisectoral mandateone agreed country-level monitoring and evaluation system.