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Executive Director of UNAIDS
since its creation in 1995 and Under Secretary-General of
the United Nations, Dr. Peter Piot comes from a distinguished
academic and scientific career focusing on AIDS, other communicable
and sexually transmitted diseases, and women’s health in the
developing world.
Using his skills as a
scientist, manager and activist, Dr. Piot has challenged world
leaders to vision AIDS within the realms of social and economic
development as well as human security.
Under his leadership,
UNAIDS has become the chief advocate for worldwide action
against AIDS, with the global mission of leading, strengthening
and supporting an expanded response to the epidemic. It has
brought together eight organizations of the United Nations
system around a common agenda on AIDS, spearheading UN reform.
Charles
Clifton: Why AIDS? Why are you so intimately involved
in this global cause? Would you please speak a bit about your
background, your interest in AIDS and how/what UNAIDS is all
about?
Dr.
Peter Piot: Perhaps unusually, the things that I thought
were important when I was first starting out as a medical
researcher were the unfashionable areas, but which were responsible
for a great deal of illness, especially in tropical Africa.
So I was working on women’s
health and sexually transmitted diseases (STDs) in the early
1980s, when AIDS first appeared. I had been working in the
then Zaire. I vividly recall returning in 1983 to see the
wards of the largest hospital filled with both men and women
suffering from this new disease. From that moment on, it was
clear that there would be a new crisis we had to deal with,
but I don’t think anyone could have foreseen just how comprehensively
and devastatingly AIDS would spread globally.
In 1994, it was becoming
clear that the epidemic was much more than just a health problem,
and needed a new kind of coordinated UN (United Nations) response.
UNAIDS was created, beginning officially on 1 January 1996,
and at that stage was the leading edge of UN reform. We bring
together eight co-sponsors in a joint focus on AIDS, ranging
from the World Bank to UNICEF and the UN Development Programme.
UNAIDS has a fairly small secretariat, with much of our staffing
comprising UN country AIDS coordinators in high priority countries
around the world. With the secretariat and co-sponsors, we
provide global leadership and advocacy, and the world’s information
about the state of the epidemic and best practices in response.
CC: Politicising
AIDS: There is a lot of noise in the U.S. media about what
the Bush administration is and isn’t doing to adequately address
the AIDS epidemic and that HIV prevention isn’t being driven
by scientifically sound approaches. In addition, AIDS activists
from around the world are directing pressure on pharmaceutical
companies and governments to do more on the international
access to treatment issue and especially in regards to allowing
for the production and distribution of generic drugs. However,
other than the problems in South Africa and occasionally Brazil,
we very seldom hear about where AIDS is on the political agenda
in other countries. Can you speak about where is AIDS on the
political and social agendas of China, other parts of Africa,
the Caribbean and Central America? What are the broad issues
as they relate to care and support, and specifically access
to antiretrovirals and treatment?
PP: Over the past
six years, we have seen more and more governments make AIDS
a political priority, breaking down the walls of silence surrounding
the epidemic. Today, we see presidents and prime ministers
throughout Africa, the Americas, the Caribbean, Asia and Eastern
Europe publicly displaying personal commitment to the fight
against AIDS. They have recognized that AIDS is not just a
health issue; it is fundamental to development, progress and
security. Dozens of countries now have national AIDS commissions
and strategies in place. In almost 30 countries, presidents
or prime ministers head them—an indication of the priority
they personally attach to the problem. Of these, 13 countries
are in Africa. These are encouraging signs.
In the Caribbean, for example,
the region’s Heads of State came together to form the Pan-Caribbean
Partnership on HIV/AIDS in February 2001. As part of the Partnership,
governments work closely with the international community
and civil society to boost national and regional responses
to HIV/AIDS.
In Africa, the Heads of State
from several countries (including Mali, Nigeria, Rwanda, South
Africa and Uganda) have come together to form AIDS Watch Africa.
This initiative enables members to alert other Heads of State
to the threat AIDS poses to development, and to encourage
them to tackle the epidemic.
China appears to be on the
brink of an explosive and generalized HIV epidemic if wide
scale, effective prevention programs are not implemented very
soon. There are already serious HIV epidemics among injecting
drug users and sex workers, and HIV is likely to spread to
the general population due to high rates of STDs (sexually
transmitted diseases), ignorance about HIV, lack of access
to condoms and sexual health services, and large-scale internal
migration. Official estimates put the number of people living
with HIV in China at one million in mid-2002. Extensive HIV
infection, of 150,000 people (and possibly many more), has
also occurred among blood donors in rural areas of central
China. The government has acknowledged the situation and is
trying to remedy it. However, there is need for greater openness
about the extent of the problem, as well as greater efforts
to address it and support those affected. UNAIDS and others
are working, for example, in the highly affected Henan Province
to increase access to care and support.
Increased access to comprehensive
HIV care and support, including antiretroviral medicines and
treatment for HIV-related opportunistic infections, is a global
priority. As drug prices drop and health systems improve,
significant progress is being made in these areas. But treatment
and care are not yet reaching the vast majority of people
in need.
A new analysis of access
to treatment shows that of the six million people in the developing
world in need of antiretroviral drug therapy, just 230,000,
less than 4% were receiving antiretroviral drugs at the end
of 2001. In high-income countries, where an estimated 500,000
people were receiving antiretroviral treatment, 25,000 people
died of AIDS in 2001. In Africa, however, where only some
30,000 of the 28.5 million people infected were receiving
antiretroviral treatment, AIDS killed 2.2 million people in
2001.
Access to adequate care and
treatment is a right, not a privilege. Although real progress
has been made in lowering the price of antiretroviral therapy
in the developing world, far greater action is needed by both
governments and the private sector to ensure that treatment
reaches those in greatest need. The cost of treatment must
continue to fall, and governments in both the developing world
and donor countries must create sustainable funding streams
to provide treatment, while strengthening the healthcare infrastructure.
CC: I attended
my first International AIDS Conference in Durban nearly three
years ago. A week prior to the conference I had the opportunity
to visit the townships outside of Capetown and clinics in
Durban. I was completely overwhelmed by what I saw and couldn’t
imagine any type of substantial response to the sheer numbers
facing the country. However, by the time the conference had
ended my attitude had completely changed, I had had a chance
to visit and talk with people working at the grassroots and
community level. Only then did I begin to understand that,
yes there is hope. There is life. There is a chance. In your
work with non-Western countries, in countries that have been
defined in the U.S. as resource-limited, what successes have
you witnessed in how people and communities have responded
to this epidemic over the last few years?
PP: Despite the fact
that the epidemic continues to grow in most regions of the
world, we do see some signs of hope where countries have managed
to reduce HIV prevalence and/or provide affordable care for
people living with HIV/AIDS.
A number of African countries
are continuing to register success in fighting the epidemic
as a result of increased commitment from governments, businesses
and communities. HIV prevalence continues to drop in Uganda—down
to 5% at end-2001, compared to 8.3% at end-1999. HIV prevalence
is falling among young urban women in Zambia—from 28% to 24%
among 15-29 year-old urban women between 1996 and 1999, and
from 16% to 12% among rural women ages 15-24.
Cambodia, like Thailand,
is showing that the “natural” course of the epidemic can be
changed. Strong political commitment and large-scale prevention
programs have helped lower adult HIV prevalence from 4% at
end 1999, to 2.7% at end 2001 in Cambodia.
By mounting a strong national
response, the Polish government has successfully curtailed
the epidemic among injecting drug users and prevented it from
gaining a foothold in the wider population.
Latin America and the Caribbean
show that middle- and low-income countries (where HIV prevalence
is still relatively low) can provide treatment and care through
the public sector. Eleven countries in Latin America and the
Caribbean now have policies and laws that guarantee antiretroviral
therapy for their HIV-positive citizens, although this does
not mean all in need receive treatment yet. Across the region,
about 170,000 people now receive antiretroviral treatment,
of which 100,000 are in Brazil.
The key to cracking this
epidemic seems to be a specific combination of community action
from the grassroots meeting leadership, not only from governments
but also from civil society, religious organizations, women’s
and youth groups, and business.
CC: Money.
There never seems to be enough. It’s been reported that something
like $10 billion is needed annually to address HIV and AIDS
in developing countries. How much money is currently being
directed towards the Global Fund? Who is at the table supporting
the Fund at the corporate, governmental and public level?
Who is missing and why? And what can we realistically expect
to be accomplished over the next few years?
PP: The Global Fund
to Fight AIDS, TB and Malaria has received total pledges over
five years of US$2.2 billion, the first $1 billion of which
was available in 2002, with a further $650 million becoming
available in 2003. In its first two rounds of grants, the
Fund committed itself to disbursing $1.5 billion in 2003 and
2004.
The idea behind the Fund
is to build an independent global/private partnership to attract,
manage and disburse new resources to fight AIDS, TB and malaria.
The Fund is not meant to replace current efforts but to raise
additional resources from new sources, at the same time as
support for current efforts is increased. The Fund’s partners—national
governments, multilateral organizations, NGOs (non-government
organizations) and the private sector—are equally committed
to supporting and assisting the Fund in its operations, and
to ensuring that resources flow rapidly to where they are
most needed.
To date, governments have
been the major contributors to the Global Fund, although there
have also been significant contributions from some businesses,
foundations, and individuals. The Fund publishes an up-to-date
list of the pledges it has received, so is very easy to see
where the money is coming from (www.unaids.org).
The Fund has been established
very quickly and made its first disbursements in near record
time, given the international context in which it is working.
The coming year is critical to maintain the Fund’s momentum.
It will be the most challenging in attracting new pledges
in a period when it is still too early to demonstrate that
the current disbursements have made a difference. UNAIDS is
working closely with the Fund, in particular to help ensure
that developing countries have the right support to make good
proposals for funding.
CC: 2004
International AIDS Conference, Thailand. If you were to look
into a crystal ball, what would you like to see at that time?
PP: At the Barcelona
conference last year, there was for the first time a Leadership
Track. I would like to see the leadership efforts at the conference
greatly expanded. Heads of state need to be there, together
with major decision makers—we’ll know we’re really getting
somewhere when finance ministers see that this sort of conference
is important. But as well, the conference needs to bring together
trade union leaders, women’s leaders, intellectuals and activists—not
necessarily just those currently in the AIDS movement.
I’d like to see the conference
reflecting a truly scaled-up response from around the world.
That means a lot more attention to the politics, economics,
and implementation research, which ought to accompany broad-scale
AIDS responses.
I hope there will be some
good news on vaccines, microbicides, and more effective and
simpler treatment regimens. With the twin messages of technological
advances and political progress, we would all be given reason
for hope.
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