Political Leadership, HIV, and Health: Keeping Leaders Accountable
April 3, 2016
By Ron MacInnis and Annmarie Leadman
This piece was first published in the Johns Hopkins Bloomberg School of Public Health's Global Health Now blog.
When Hillary Clinton praised former United States First Lady Nancy Reagan for “starting the conversation on AIDS” during Ronald Reagan’s presidency, she invited backlash from those who recall the dark days of the epidemic in the 1980s. Secretary Clinton quickly apologized for her misstep but the remark recalled the ignominious failures of American political leaders to take action on AIDS.
Statements and actions by political leaders, whether informed or not, have repercussions. Ugandan President Yoweri Museveni recently questioned voluntary male medical circumcision as an HIV prevention method, despite massive evidence of its impact in reducing transmission. Kenyan President Uhuru Kenyatta dismissed LGBT rights as a non-issue at a press conference with President Obama last summer.
In the lead-up to the UN High-Level Meeting on Ending AIDS, to be held in New York in June, these incidents shine light on the importance of political leadership to meet ambitious goals to help end the AIDS epidemic—and the need for civil society to set demands and hold government accountable for their stances and promises.
When they meet, UN member state representatives will draft a new political declaration on HIV/AIDS. Declarations have proven useful as global tools to set commitments and priorities, harmonize approaches, and provide a reference point for advocates, but the impact of such declarations in high-burden countries is mixed.
Attention paid to HIV issues during elections in high-burden countries, including those in Kenya, Tanzania, and Uganda, is a good indicator of political will and leadership. Most political leaders, like the Reagan presidency before them, ignore HIV as a topic in party platforms. While they may broadly reference health—for free primary healthcare services, for example—many fail to acknowledge donor-subsidized HIV health commodities, services, and staffing, or the growing need to mobilize domestic resources as donor funds shrink.
Another indicator is the level of HIV funding political leaders fight to include in domestic budgets. In Tanzania—with an estimated 1.4 million people living with HIV and AIDS (PLHIV), and more than 73,000 new infections estimated to occur every year, leading candidates in last year’s presidential election offered no plan to address the expected HIV/AIDS funding gap.
Growing civil society advocacy movements are demanding that candidates prioritize HIV financing and clinical reforms, and calling on voters to elect leaders committed to these and other health priorities. For example, in the lead-up to Uganda’s recent election, 62 civil society organizations issued a “Civil Society Health Manifesto, 2016–2021,” with clear demands.
This week, ahead of the June 2016 UN high-level meeting, civil society advocates and community service representatives will gather in New York to outline their political leadership visions on HIV. There is a collective unease among those on the front lines of the HIV response, including millions in need of lifelong HIV treatment. They are concerned about global HIV targets that may be interpreted too optimistically by political leaders in high-prevalence countries, overly simplistic messaging on “ending AIDS,” and the lack of emphasis on HIV in the Sustainable Development Goals that may signal a receding sense of urgency around the epidemic. This week’s UN meeting presents an ideal opportunity to present clear demands to political leaders and ensure that their new declaration is ambitious, actionable, and realistic.