HIV/AIDS

This testimony, which summarizes the findings of a July 1998 report (GAO/NSIAD-98-202), focuses on international efforts to combat the spread of the AIDS virus in the developing world. GAO reviewed efforts by the U.S. Agency for International Development (USAID) and the United Nations at their headquarters and in the Dominican Republic, Honduras, India, the Philippines, and Zambia. GAO discusses (1) USAID's response to the HIV/AIDS epidemic in the developing world and (2) the progress since 1996 of the U.N.'s efforts, commonly called UNAIDS, to coordinate U.N. activities and mobilize the international response to the epidemic.

GAO noted that: (1) although HIV/AIDS continues to spread at a rapid rate in the developing world, AID has made important contributions in the fight against the disease; (2) AID supported research that helped to identify interventions proven to curb the spread of HIV/AIDS; (3) these interventions have become the basic tools for the international response to the epidemic; (4) the evidence GAO gathered suggests that AID projects have increased awareness of the disease, changed risky behaviors, and enhanced access to treatment of sexually transmitted diseases and to condoms, which have helped slow the spread of the disease in target groups; (5) for example, in the Dominican Republic, AID's efforts contributed to reduced incidence of HIV among targeted commercial sex workers; (6) in one clinic funded by AID, the percentage of commercial sex workers testing positive for HIV/AIDS dropped from 5.8 percent in 1995 to 3.5 percent in 1996; (7) to date, the U.N. has made only limited progress toward meeting its goal of leading a broad-based, expanded, and well-coordinated worldwide effort to prevent the transmission of HIV/AIDS; (8) while information is not yet available to measure UNAIDS' progress in promoting increased spending by donor countries, the private sector, or affected countries, available data indicate that U.N. cosponsor agencies have not raised their overall spending on HIV/AIDS as had been anticipated; (9) U.N. spending declined from $337 million in 1994-95 to $332 million in 1996-97 after the creation of UNAIDS; (10) the UNAIDS Secretariat has only just begun to establish a framework for measuring the performance and objectives of the U.N.'s HIV/AIDS program; (11) in addition, success with so-called theme groups, which were designed to create a single focus and strategy for cosponsors at the country level, has been uneven; (12) in some countries, cosponsor agencies conduct joint projects and meet regularly, while in others, they are just beginning to work together; (13) moreover, theme group representatives told GAO that the UNAIDS Secretariat has not provided useful technical assistance and best practice information to facilitate their activities; (14) available quantitative and qualitative data show that USAID has had success in reducing the incidence of HIV/AIDS among targeted groups; (15) moreover, experts agree with the overall approaches of both USAID and UNAIDS; and (16) however, the continued rapid rate at which the disease is spreading in the developing world would suggest that a larger response may be required to slow the spread of the disease.