In his address to this week’s international AIDS conference in Vienna, Bill Clinton told some home truths about aid for HIV: “In too many countries, too much money pays for too many people to go to too many meetings and get on too many airplanes to do too much technical assistance.” A good start to cutting the waste derided by the former US president would be to close down UNAIDS, the UN’s lobbying organization that costs tax-payers the best part of a billion dollars a year. It was set up in 1996 by UN agencies claiming that HIV was so special it should be removed from the purview of the World Health Organization. From the start, UNAIDS has been self-serving, providing the UN with data and arguments for massively expanding HIV funding regardless of HIV’s place in global health priorities or the cost-effectiveness compared with other health needs. Much of its data and arguments have been proved wrong and much of its lobbying has been based on alarmist prevalence figures (in 2007 it had to halve its estimates for India and other countries) and misleading projections, like the pandemic long-predicted to be just about to hit East Asia and which never has (no thanks to UNAIDS). This has contributed to disproportionate HIV spending across Africa in countries such as Ethiopia, Rwanda and most of West Africa where prevalence is low, stable or declining. Data from a few hard-hit southern African countries has been used to secure an excessive 25% share of global funding for health, depriving the fights against bigger killers such as malaria and diarrhoea. In addition to claims of impending disaster, UNAIDS has been slow to listen to scientific evidence that was inconvenient. This includes the UNAIDS mantra that HIV is a “disease of poverty,” wilfully ignoring the evidence of many years that prevalence is higher in the middle classes of Africa than the poorer. On prevention, the record of UNAIDS has been dismal. It has resisted admitting the key role of concurrent sexual partners in driving transmission, instead promoting broad prevention schemes aimed at the general population, most of whom are at minimal risk. UNAIDS has not hesitated to take credit for recent data showing global declines in HIV rates but in fact HIV has been declining in Africa since the late 1990s, before UNAIDS was working and before the huge input of money. The decline is more a result of the natural course of the disease. How important is HIV? Globally it is insignificant, accounting for less than 3% of deaths. Even in Africa, HIV is not significant for the vast majority of the continent’s 53 countries. Excluding just five countries with the highest number of HIV deaths (South Africa, Swaziland, Botswana, Lesotho and Zimbabwe) relegates HIV for the rest of Africa to around 6% of deaths--below deaths from diarrhoea, childhood diseases, malaria, respiratory infections, cardiovascular diseases, maternal and perinatal conditions, and accidents and injuries. Yet this week in Vienna UNAIDS continues with its misleading propaganda that, globally, AIDS is the biggest killer of women of reproductive age, when this is true in only a handful of southern African countries. For the cost of putting four million people on expensive HIV treatment, we could save the lives of 10 million children every year from pneumonia and diarrhoea that are simple and cheap to treat--and no less fatal. It is a tough choice--but most people don’t even realise it is a choice or who has been doing the choosing and why. President Barack Obama is right to shift new aid to supporting all health needs not just one disease, an approach mirrored by the UK’s Department for International Development. The self-serving lobbying of UNAIDS, by contrast, illustrates vividly the folly of a single-disease UN agency. Time to put those billions of dollars to better use. Roger England is Chairman of the Health Systems Workshop, an independent think-tank promoting health systems reform in poor countries. He has worked for several international agencies including secondments to the World Bank and the World Health Organization. By Roger England