LONDON — HIV/AIDS advocates have mixed views on the five candidates shortlisted to lead the Joint United Nations Programme on HIV/AIDS, but agree there is much at stake as the agency fights for its existence.
Secrecy surrounds the process to replace former executive director Michel Sidibé, who left in May this year amid controversy over his handling of harassment and bullying at the agency.
The shortlist for the next UNAIDS executive director is out.
The names of five shortlisted candidates emerged in June, including four from Africa and one woman. A final decision was expected earlier this month, but insiders say the process has been delayed.
Last month, NGO delegates on the UNAIDS Programme Coordinating Board — a collection of stakeholders that guides the agency’s work — said they want the next executive director to be from the global south. They have endorsed Winnie Byanyima, currently executive director of Oxfam International; Bernard Haufiku, Namibia’s former minister of health; and Salim Abdool Karim, director of the Centre for the AIDS Program of Research in South Africa.
“It is no exaggeration to say that [António Guterres’] choice may determine the future fate of the AIDS epidemic.”— Richard Horton, editor, The Lancet
The other two candidates are Sani Aliyu, director general of the Nigerian National Agency for the Control of AIDS, and Chris Beyrer, a professor at Johns Hopkins Bloomberg School of Public Health.
The final decision lies with the U.N. secretary-general, although a selection committee is expected to further narrow down the shortlist to two or three candidates.
Whoever triumphs will be taking on the double challenge of leading an organization that is facing questions over its credibility and relevance, and at a precarious time for the HIV/AIDS response.
“It is no exaggeration to say that his choice may determine the future fate of the AIDS epidemic,” Richard Horton, editor of The Lancet, recently wrote.
While AIDS-related deaths and new HIV infections have been declining, progress on both remain far from the 2020 target of fewer than 500,000 a year each. In 2017, the latest available data from UNAIDS, 940,000 people died from AIDS-related illness and there were 1.8 million new infections.
Meanwhile, the new director will need to rebuild UNAIDS’ shattered reputation after allegations of abuse of power pushed it into crisis last year. They could also be called to justify UNAIDS’ existence or define its future direction — similar questions came up when Peter Piot left in 2008.
Christine Stegling, executive director of the International HIV/AIDS Alliance, recently renamed Frontline AIDS, said she was pleased with the quality of candidates.
UNAIDS is “such a troubled agency” it was not certain that “good people would step forward and take on the challenge,” she said. “We are lucky to be in a position where we have a strong field of candidates. It shows confidence in the agency and importance people attach to it.”
Insiders say the agency needs a leader with strong technical expertise. While Sidibé did a good job at setting ambitious targets and successfully corralled support for pulling together around common goals — especially among African leaders — his “sloganeering” sometimes lacked evidence and follow-through, they said.
However, opinions vary on who should take the top job from a diverse shortlist that includes former politicians, medical scientists, and an NGO leader.
Byanyima is the only woman and is expected to go forward to the next round, a number of insiders told Devex. Some have welcomed the prospect of a black African woman heading up the agency, especially in light of the allegations of sexual harassment within UNAIDS.
A number of advocates said they were disappointed not to see more women on the list. A source close to the process told Devex that only a fifth of the more than 250 people who applied for the job were women.
Others point out that Byanyima is the only nonphysician on the list and has not worked specifically on HIV/AIDS, although she is a member of the U.N.’s High Level Panel on Access to Medicines.
Her high profile also means she has come under more scrutiny than the other candidates — for her handling of a major 2017 restructuring effort at Oxfam, for example, which one insider described as “messy,” and the recent sexual abuse scandal that has shaken the NGO.
One former Oxfam official, who asked to remain anonymous, said they respected her leadership in taking practical action and supporting morale at the height of the scandal.
During the PCB meeting last month, Africa NGO delegate Lucy Wanjiku Njenga said Byanyima’s recent experience means she will be “brilliant in implementing the monumental task of supporting staff during ... transitions, reasserting [UNAIDS’] values and [helping] win back the respect and credibility that UNAIDS needs.”
But groups advocating for the rights of sex workers, a key population for the sector, raised concerns about Oxfam’s position on transactional sex, which they fear could spill over to UNAIDS.
Since 2017, Oxfam’s code of conduct has banned its staff from paying for sex under any circumstances in order to “challenge sexually exploitative and abusive behaviour.” This is in line with the official U.N. position on the conduct of humanitarian workers, and Oxfam was far later than most major aid agencies in introducing it.
However, sex worker groups have challenged the view as they campaign to decriminalize sex work.
“We have some concerns about the Oxfam policy … for its underlying conflation of sexual exploitation and sex work [and] our concern focuses on whether or not that belief coming into UNAIDS would alter the rights-affirming approach it takes around sex workers,” Ruth Morgan Thomas from the Global Network of Sex Work Projects, told Devex.
Salim Abdool Karim
In contrast, Karim is already well-known in the HIV/AIDS community, having contributed a body of research to understanding the epidemic in South Africa. He was among the scientists who tried to prove the link between HIV and AIDS at a time when the South African government denied it.
His work demonstrating the relationship between intergenerational sex and HIV transmission in the country was pivotal in developing strategies to curtail the epidemic, said Glenda Gray, who now leads the South African Medical Research Council, formerly led by Karim.
Karim had led a “difficult” process to reform the council, Gray said, which she described as having been a “bloated, mediocre science council” with “poor funding and lots of inefficiencies” before he arrived. Karim scaled down units that weren’t productive and was able to boost government funding.
“He did the dirty work in reforming the Medical Research Council, which is what is needed at UNAIDS at the moment,” Gray said.
The preliminary results of one of the largest HIV surveys ever undertaken suggest so.
Aliyu, who was called back to Nigeria in 2016 to help turn the tide against HIV/AIDS, led the country’s largest HIV population-based survey, which became a “game-changer for the national response,” said Edward Kallon, U.N. resident and humanitarian coordinator in Nigeria. The recent results of the survey helped launch the country’s revised HIV/AIDS strategy for 2019-2021.
Kallon described Aliyu as someone who maintained an “excellent and close working relationship with the U.N. system, even beyond the HIV sphere, to agencies supporting the broader health sector.”
Lola Dare, president and CEO at Centre for Health Sciences Training, Research and Development, who knew Aliyu through her work with the Nigerian AIDS agency NACA, argued his experience in Nigeria — coordinating 36 states and a diverse set of partnerships and programs — would serve him well at UNAIDS.
She felt he could have done better in integrating HIV/AIDS into the broader health system — a challenge she would like to pose to all the candidates.
Previously president of the International AIDS Society, Beyrer is regarded by current IAS Executive Director Kevin Osborne as a “solid manager” who “brings really strong human rights, social justice approaches to HIV” — he is the founding director of the Johns Hopkins Center for Public Health and Human Rights.
“That's what [he’s] consistently done — [making] sure that issues around human rights are not just a soft issue, but they're intrinsic to how we make progress and it's linked to science,” Osborne said.
Several advocates Devex interviewed also spoke positively about Beyrer’s experience working in Asia. The region has been “neglected” by UNAIDS in recent years, they said. If appointed, Beyrer could help rebalance its attention on Asia and Eastern Europe, as well as Africa.
However, others said it was unlikely that, as a white American, Beyrer would get the job.
Haufiku is currently special adviser on health in the office of the vice president of Namibia and was health minister from 2015 until December 2018. Under his leadership, Namibia made significant progress against UNAIDS’ 90-90-90 targets.
Preliminary findings of a survey conducted in 2017 showed 96.4% of people living with HIV are on antiretroviral therapy, and of those receiving ART, 91.3% have viral suppression, meaning they cannot pass it on. About 86% of those surveyed also reported being aware of their HIV status.
During his time in office, Haufiku helped get approval for a sexual and reproductive health and rights strategy from health ministers from the Southern African Development Community, which U.N. Population Fund described as “groundbreaking.” He is also a SheDecides champion.
The former health minister “really knows about politics, has a history of standing up for women’s rights, and is also renowned for taking bold steps against corruption and mismanagement,” according to Robin Gorna, former co-lead for SheDecides.