The global response to the HIV/AIDS epidemic has been unprecedented. Financing for prevention, treatment, care and support activities in developing countries has increased tenfold in developing countries over the past several years. In 2005, for the first time, resources were sufficient for an appropriate response (although maintaining resources in the longer term remains a challenge, with increasing resource gaps projected).
However, in many cases the sheer number of donors with differing stipulations on how the money should be spent, handled, monitored and reported on has overwhelmed resource-poor countries with limited human resources. Trying to dramatically increase the delivery of services to communities in a short period of time has also challenged national capacity. This may be especially true in countries experiencing ‘brain drain' or loss of staff from HIV-related morbidity and mortality.
A quarter-century into the epidemic, the global response must be transformed from an episodic, crisis-management approach to a strategic response that recognized the need for long-term commitment and capacity building, using evidence-informed strategies that address the structural drivers of the epidemic.
The response must become stronger, more strategic and better coordinated if the world is to achieve universal access to comprehensive HIV prevention, treatment, care and support by 2010. This in turn requires that the many actors responding to AIDS at the global, national and local levels fully coordinate and harmonize their efforts.
To tackle this problem, in September 2003 a working group at the 13th International Conference on AIDS and Sexually Transmitted Diseases in Africa approved a set of guiding principles for making money work harder at the country level. In April 2004, the Consultation on Harmonization of International AIDS Funding – bringing together representatives from governments, donors, international organizations and civil society – endorsed the ‘Three Ones' principles as follows:
One agreed AIDS action framework that provides the basis for coordinating the work of all partners
One national AIDS coordinating authority, with a broad-based multisectoral mandate
National ownership of plans and priorities is the overarching theme of the Three Ones. These principles also emphasize the idea that urgently needed responses should contribute to developing national capacity and fit into broader national development strategies. They are also fully aligned with ongoing efforts for UN reform, which aim to streamline and harmonize multilateral assistance, as well as with the Millennium Development Goals, which provide an internationally-agreed upon framework for improving lives.
Achieving full application of the ‘Three Ones' principles is a key priority of the United Nations system. UN Theme Groups on HIV/AIDS are the main vehicles through which agencies in the system coordinate their activities at the country level. UNFPA chairs UN Theme Groups on HIV/AIDS in about one in five of its programme countries.
Universal access to prevention, treatment, care and support is the internationally agreed-upon goal of the global response to HIV/AIDS. This will require a massive scaling up of the most effective programmes, and will require strengthening HIV prevention and HIV treatment programmes simultaneously – building on existing synergies – to increase impact and ensure sustainability. At the 2005 World Summit, the international community agreed to provide universal access to reproductive health by 2015. A 2006 political declaration calls for universal access to comprehensive prevention, treatment and care for HIV or AIDS by 2010. Closer linkages between sexual and reproductive health and HIV/AIDS programming can help make both of these international goals a reality.
Achieving universal access will require broad participation and a strong country focus, as called for in the Three Ones. It demands finding practical ways to overcome obstacles to scaling up, building on decisions already made. The Three Ones process encourages countries to set their own roadmaps – including midpoint targets and milestones – for themselves in order to advance toward universal access and to achieve the Millennium Development Goal on HIV/AIDS.
UNFPA is finding more and more ways to complement the government programmes, especially in the areas of adolescent sexual and reproductive health, with technical expertise, both at national and state levels. UNFPA's ongoing regionalization will support an even more country-focused approach. UNFPA is fully committed to working within UN teams and with a broad array of other partners, and to sharing its knowledge and expertise so as to make programming as efficient and effective as possible.