The Lancet: Rehabilitate UNAIDS to reflect HIV/AIDS community values

SOURCE: The Lancet HIV
Editorial
Posted January 1, 2019

From the discovery of the virus in the early 1980s to delivery of care within communities today, women—renowned individuals and countless people whose names will not be noted in the history books—have been at the very core of the HIV response. Women lead prominent research institutions, international and national societies, and efforts to deliver care. The staggering, fantastic diversity sets the global HIV/AIDS response apart from other health specialties, and is indicative of the principles of equality, openness, and egalitarianism that underpin the response. So, when the sexual harassment scandal rose to prominence in the Hollywood film industry in 2017, perhaps naively, we did not foresee that a year later the global HIV response would need its own #MeToo movement.

Earlier this year it emerged that senior figures at UNAIDS had been accused of sexual harassment, and it quickly became apparent that the agency's systems to address widespread complaints of bullying and harassment were not fit for purpose. Despite professing a zero-tolerance policy towards harassment and bullying, the organisation was accused of not only tolerating inappropriate and threatening behaviour, but seemingly operating with a toxic culture. Accusations went right to the top, with Deputy Executive Director Luiz Loures accused of sexual harassment and Michel Sidibé, Executive Director of UNAIDS, accused of dismissing initial reports and interfering in the process.

After a flurry of claims and counterclaims, an Independent Expert Panel was set up to investigate the culture at UNAIDS: its report, made public on December 7, is damning. The panel, chaired by Gillian Triggs (former President of the Australian Human Rights Commission) found that the “UNAIDS Secretariat is in crisis, a crisis which threatens its vital work”. The report describes “a broken organisational culture”, “a vacuum of accountability”, and “a work culture of fear, lack of trust, and retaliation”.

These revelations will be a punch in the gut for many who have given so much to fight against HIV/AIDS, who thought the community and its leaders were better than that. From the earliest days the fight has been against the systems and mechanisms that perpetuate imbalances of power: inspired by activists and the marginalised patients that it serves, the global AIDS response by scientists, researchers, and clinicians has been one built on principles of equity and transparency. Few movements have done more to shine a light on global injustices; so the revelation of this rotten centre at a global pillar of the response is a bitter blow.

Sidibé was initially defiant in the face of accusations earlier in the year—but as director of the organisation, the buck stops with him. Since the publication of the report, Sidibé has announced his intention to resign from the post of UNAIDS Executive Director in June 2019, 6 months before his term is due to end.

Given the findings of the panel, a swifter exit of the leadership of UNAIDS would be welcome—the reluctance of UN Secretary-General António Guterres to step in and insist on change reflects poorly on the UN. As it stands, the onus falls on the UN and on Guterres more specifically to ensure that systems are put in place at UNAIDS to ensure that such a culture can never develop again: systems that live up to the UN's avowed commitment to zero-tolerance to sexual harassment and bullying, that enable complaints to be heard and investigated thoroughly, swiftly, and fairly, and that take apart the structures that have formed over the past decade and allowed a toxic culture to develop and flourish. Implementation of the independent panel's recommendation for a body external to UNAIDS where complaints of harassment—including sexual harassment, bullying, and abuse of power in all its forms—are first received would go a long way towards making a meaningful change.

The fight against HIV/AIDS has done so much to put notions of equity, equality, fairness, and human rights to the front of the global health agenda, and women have been essential to every aspect of the response over the past four decades. Gender-based violence is a driver of HIV and a barrier to an effective response, and that it has been allowed to occur in UNAIDS is a tragic irony. Although currently in a state of disrepute, a rehabilitated UNAIDS still has an important part to play. When UNAIDS considers its future and how to rebuild its organisation to ensure a safe, inclusive, respectful, and professional workplace, those appointed to leadership should reflect the values of the HIV/AIDS community and honour the important contributions of women to the movement.

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(UN Photo / Eskinder Debebe)