The U.N. Specifically, we examined (1) the contributions USAID has made to the global effort to prevent HIV/AIDS, and the methods USAID uses to provide financial oversight for its HIV/AIDS prevention activities; and (2) the extent to which UNAIDS has met its goal of leading an expanded and broad-based, worldwide response to the HIV/AIDS pandemic. To determine whether UNAIDS has achieved its goal to lead an expanded and broad-based, worldwide response to the HIV/AIDS epidemic, we measured progress against criteria set forth in the U.N.’s Economic and Social Council resolution endorsing the creation of a Joint United Nations Program on HIV/AIDS, the memorandum of understanding signed by the six cosponsoring agencies, and the strategic plans of the UNAIDS Secretariat and the cosponsoring agencies. USAID’s main contributions have been (1) support for research that helped to identify interventions ultimately proven in clinical trials to prevent HIV transmission; and (2) implementation of projects at the country level that increased awareness of the disease, reduced risky behaviors, and increased access to treatment of sexually transmitted diseases (STD) and to condoms, which have helped slow the spread of the disease in target groups. Under the terms of these agreements, the primary responsibility for financial oversight rests with recipients. Recipient organizations have the primary responsibility for financial management. OIG officials said that there were no indications from audits conducted of systemic problems. USAID managers primarily rely on pre-award evaluations, review of quarterly expenditure reports, and annual audits for their financial oversight of its funding recipients. The Joint U.N. Programme on HIV/AIDS Has Made Limited Progress

UNAIDS has made limited progress toward achieving its goal of leading a broad-based, expanded worldwide response to the HIV/AIDS epidemic. In some countries, cosponsor agencies are just beginning to work together in theme groups. Finally, the UNAIDS Secretariat has not been very successful in providing technical assistance and other support to facilitate theme group activities and has only started to establish a framework to measure performance. U.N. However, data are not available for 1997. Thus, it is not possible to determine whether UNAIDS’ first year’s efforts have led to increased spending by donors. We saw examples of private, in-country activities that indicated that companies could play an important role in the U.N.’s efforts to reduce the spread of HIV/AIDS. As an international organization, the United Nations is not required to comply with the U.S. U.N. 3.2).
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed the human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) prevention activities of the Agency for International Development (AID) and the United Nations' (U.N.) Joint Program on HIV/AIDS (UNAIDS), focusing on the: (1) contributions AID has made to the global effort to prevent AIDS and the methods AID uses to provide financial oversight over its AIDS prevention activities; and (2) extent to which the United Nations has met its goal of leading an expanded and broad-based, worldwide response to the HIV/AIDS epidemic.

What GAO Found

GAO noted that: (1) AID has made important contributions to the fight against HIV/AIDS; (2) AID-supported research helped to identify interventions proven to curb the spread of HIV/AIDS that have become the basic tools for the international response to the epidemic; (3) applying these interventions, AID projects have increased awareness of the disease; changed risky behaviors; and increased access to treatment of sexually transmitted diseases and to condoms, which have helped slow the spread of the disease in the target groups; (4) under the terms of cooperative agreements with private implementing organizations, AID managers are expected to closely monitor projects, but the major responsibility for internal financial management and control rests with recipient organizations; (5) AID's financial oversight primarily consists of conducting preaward evaluations of prospective funding recipients, reviewing quarterly expenditure reports, and requiring audits; (6) officials from AID's Office of Inspector General said that there were no indications of systemic problems from audits conducted; (7) in its first 2 years of operation, the U.N. has made limited progress in achieving its goal of leading a broad-based, expanded global effort against HIV/AIDS; (8) while data indicate that spending by the cosponsors has not increased, data are not yet available to measure the U.N.'s progress in increasing spending by donor countries, the private sector, or affected countries; (9) moreover, theme groups, the forum for coordinating U.N. efforts in the field, have had a difficult start and, in some countries, cosponsor agencies are just beginning to work together; (10) the UNAIDS Secretariat has not been successful in providing technical assistance and other support to facilitate theme group activities and performance measures for the U.N.'s HIV/AIDS programs; and (11) despite the U.N.'s limited progress in meeting its objectives, GAO observed innovative and low-cost activities that were implemented by cosponsor agencies.