Tuesday, October 24, 2006

Questions from Civil Society to All Nominees for WHO Director General

These questions were proposed to all WHO Director Nominees. Stay tuned--we will post their responses as they come.

1. Global commitments have been made to universal access to HIV/AIDS prevention, care, treatment and support. For example, the African Union (AU) Common Position commits to doing everything possible to achieve 80% coverage of adults and children in need of antiretroviral treatment (ART) by 2010. Do you support the establishment of similar targets for other regions? How, specifically, will the World Health Organization (WHO) contribute to reaching these goals in Africa and in other regions?

2. The promotion of basic human rights is essential to the global response to HIV/AIDS. Medical and public health approaches to the epidemic must address basic human rights concerns at all levels, yet tension often exists between public health and human rights communities. In what specific ways do you see WHO responding to human rights concerns as a fundamental aspect of public health and medical approaches to prevention, treatment and care across the board?

3. How, specifically, will you ensure that the involvement of civil society--including people living with HIV/AIDS and vulnerable groups—is a priority at all levels of decision making, from the setting of funding, policy, and programmatic priorities through the design, implementation, monitoring and evaluation of prevention, care, treatment, and support programs? For example, a major concern for civil society right now is the development and dissemination of new guidelines by WHO for provider-initiated testing without adequate concern either for basic human rights principles and/or adequate transparency and accountability in the consultation process to develop these guidelines. How will you ensure adequate global consultation, comment, and critique on issues of voluntary counseling and testing versus provider-initiated testing and by what means will you include civil society actors in monitoring and accountability in these areas?

4. How will WHO tackle the challenges of TB/HIV co-infection, and move to help countries achieve universal access to the full WHO-recommended package of 12 collaborative TB/HIV activities in all health systems, particularly in countries with high HIV burden? How will WHO address the increasing epidemics of MDR- and XDR-TB?

5. The advancement and protection of sexual and reproductive rights are crucial in the response to HIV/AIDS. Gender inequality, gender-based violence and discrimination fuel the spread of HIV among women, girls, LGBT and other populations and are both cause and consequence of the spread of HIV infection and other urgent public health problems. How will WHO deal with these issues specifically as integral to all of the work of the organization and health systems under your tenure and as integral to the response at every level of law, policy, and health practice within member countries?

6. Specific populations are particularly vulnerable in the epidemic, including those already marginalized by social stigma and widespread discrimination and routinely denied their basic human rights. These groups include, among others, intravenous drug users (IDUs), commercial sex workers (CSWs), gay, lesbian and transgender persons, men who have sex with men (MSM), and undocumented migrants. Rather than promoting their basic human rights, governments often seek instead to criminalize and further marginalize these groups. How—specifically--will WHO work to protect the right to health for all these groups? How can WHO, for example, help advance the rights of IDUs, CSWs, MSM, and others as an integral part of an effective global response to the HIV/AIDS epidemic, especially in countries where these rights are not protected? By what means will WHO seek to ensure effective and adequate services are made available to those in prison settings? How will WHO work to advance rights-based public health approaches over efforts to further marginalize and/or criminalize vulnerable groups?

7. The world continues to fail in delivering on universal access to an essential package of AIDS commodities that includes: antiretroviral medicines (for both treatment and prevention of HIV infection); drugs to treat and prevent tuberculosis, hepatitis C, sexually transmitted infections (STIs) and other co-infections; HIV testing kits and other diagnostic technologies; home-based care kits and related essentials; breast milk substitutes; male and female condoms, substitution treatments; and clean injecting equipment. In what ways will WHO lead in filling these gaps?

8. All prevention interventions must include complete and accurate evidence-based information about HIV/AIDS prevention and treatment at the level of the individual. “Conscience clauses” and “opt-outs” can not trump the rights of individuals to fully informed choices and consent. How will you seek to bridge the increasing ideological divide undermining access to comprehensive prevention interventions worldwide? Prevention and treatment must also be linked in meaningful ways: Today, for example, only a small share of pregnant women living with HIV have access to services for the prevention of mother-to-child transmission, and few of those accessing PMTCT have sustained access to treatment for themselves. In what ways will WHO help to bridge these and other gaps?

9. How do you envision WHO’s work with generic producer countries and less developed country governments without manufacturing capacity to set precedents for the use of TRIPS flexibilities including compulsory licenses for export of first- and second-line anti-retrovirals?

10. UNAIDS estimates that the world needs to provide between $20 billion to $22 billion by 2008 to fund a comprehensive response to HIV/AIDS. How will WHO work with donors, multilaterals (GFATM, UNAIDS, World Bank), and countries around the world to assure the necessary resources are mobilized and deployed? How will you work to end the unnecessary institutional friction in Geneva between UNAIDS and WHO and to ensure that GTT recommendations on harmonization and alignment of multilaterals are implemented?

11. Finally, what is your vision of the role of WHO in promoting needed research and development on HIV, TB, malaria, and other global killer diseases to ensure that health-related Millenium Development Goals are met and that new generations of more effective diagnostics, treatments, and vaccines, including a vaccine and ultimate cure for HIV/AIDS, are developed?

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