I’ve been closely following the progress of the Investment Framework for HIV since it was published in the Lancet in 2011. We’re now a year on, and important progress has been made, but if the Investment Framework (IF) is to truly make an impact on the epidemic it needs buy-in of key stakeholders and clear ownership and coordination.
For those unfamiliar with the IF, it captures all of the good, evidence-based work and lessons learnt throughout the last 30 years of the HIV response. It places this learning in a framework, and demonstrates the incredible impact that investing in the right approaches for the right populations would have.
Here at the International HIV/AIDS Alliance we welcomed the IF, and you can read more about it in our Discussion Paper.
We need buy-in
What has become clear over the past year is that for the Investment Framework to be effective, it has to have the buy-in of the myriad of key stakeholders in global, regional and national HIV responses who would be the ones taking it forward. If people felt that the IF was driven by northern donors or by a particular multilateral rather than by the needs of people on the ground then it would rightly come under heavy fire.
The initial explanation of the IF in the Lancet, was co-ordinated by UNAIDS and co-written by a range of high-level players in the HIV response from across the technical agencies and funding mechanisms. In order to establish itself, the IF needed a clear process that ensured meaningful consultation with and appropriation by all key stakeholders in the HIV response. Following some initial kick-back from the December 2011 UNAIDS Programme Coordinating Board (PCB), UNAIDS has worked hard over the last year to build the foundations necessary. These foundations include: a series of papers and presentations further explaining the IF; a restructure that has resulted in new posts specifically designed to help deliver the IF at country, regional and global level; consultations for civil society in Africa, Asia and Latin America; support to country governments eager to be in the first wave of countries to implement the IF; and most recently, ensuring that the IF is the foundation of key funding approaches by major donors and the new funding model being developed by the Global Fund for AIDS, TB and Malaria.
The IF has had a remarkable trajectory – faltering at times but relentless, driven as it is by a logic that is difficult to refute. The Investment Framework (or its approach) was clearly the dominant idea running through the recent Washington International AIDS Conference, irrespective of whether it was explicitly referenced or not.
Ownership and coordination
But now I believe that the IF finds itself at a crossroads. In a sense many of the principles of the IF can be taken forward independently. For example, the US government will be applying the principles of the IF in its blueprint for an AIDS-free generation that it will publish on world AIDS day but rarely seems to name the framework itself. This is fine but we must not forget the huge value of maintaining the IF as a current, living and developing approach, whose growth and integrity is co-ordinated by a globally accepted representative body.
At the recent Bangkok IF consultation meeting for concentrated epidemics, there was substantial discussion by many of the key populations networks and other stakeholders present that the IF diagram and guidance needs to be specifically tailored to concentrated epidemics. The important questions then arose of who would do this and how, but were not resolved. Inevitably it is critical that motivated individuals, groups, organisations or governments should be able and encouraged to add to the knowledge base and explanation of key components of the framework. But there must also be a body that can host all the information in one place and maintain some sense of version control. Otherwise it will be a short walk to relativism, multiple interpretations of the principles and the evidence, and profusion of conflicting tools and papers.
My personal feeling is that it is UNAIDS mandate to co-ordinate the global HIV response and therefore should stay as co-ordinating body for the IF. This role will be tested now as the Global Fund new funding model assimilates the Investment Framework approach and links the HIV Investment Framework to those of TB, Malaria and a newly developing Health and Community Systems Strengthening Investment Framework. There may also be some challenging sessions ahead at the UNAIDS PCB as some stakeholders may try to fight the irrefutable logic of the IF. We all need to be prepared to face those challenges head on. If UNAIDS can’t play this role then it is imperative to set up a global co-ordinating body for the IF that has all key stakeholders represented.
The end of AIDS is in sight and I strongly believe that the IF provides us with the best structure on which to hang all the tools and evidence we need to achieve it.