UNAIDS boss: Better act now<\/p>\n
Tantri Yuliandini, The Jakarta Post, Jakarta<\/p>\n
Peter Piot may have studied as a medical doctor at the University
\nof Ghent (1974) and hold a PhD in microbiology from the
\nUniversity of Antwerp (1980), but his interest goes beyond the
\nmolecular structure of diseases.<\/p>\n
The 54-year-old executive director and initiator of the Joint
\nUnited Nations Program on HIV\/AIDS (UNAIDS) is far more
\ninterested in the \"why\" of diseases: why people become ill and
\nwhy some are more affected than others.<\/p>\n
During his three-day visit here to launch the Indonesian
\nNational Strategy Against HIV\/AIDS 2003-2007, Piot managed to fit
\nin a 10-minute interview with The Jakarta Post amid his tight
\nschedule.<\/p>\n
Here is an excerpt from the interview:<\/p>\n
Question: This is not the first National Strategy program that Indonesia
\nhas launched for HIV\/AIDS (Human Immunodeficiency Virus\/Acquired
\nImmune Deficiency Syndrome). The first program was launched in
\n1994, but instead of reducing the number of people infected with
\nHIV\/AIDS, the number has actually increased. What are your views
\non this?<\/p>\n
Answer: I think the big difference between 1994 and today is that in
\n1994 there were hardly any people with HIV in the country, and so
\nI would say it was far more difficult to mobilize society when
\nthe problem is really not there.<\/p>\n
Today, HIV is really here in Indonesia. Also, today there is,
\nI would say, a far bigger engagement at the top level in the
\ncountry on AIDS.<\/p>\n
We've learned from other countries that it's better to act
\nnow, or very early on, for several reasons.<\/p>\n
One, it's easier, and because the epidemic is far more
\nconcentrated in people who are at highest risk. The most
\nvulnerable are injecting drug users, sex workers and their
\nclients. We shouldn't blame prostitutes, because there would be
\nno prostitution without the men going there.<\/p>\n
Second, it's much cheaper. If one waits until there are lots
\nof people who are infected and need treatment, that's very
\nexpensive. The impact on the economy would also be bigger.<\/p>\n
Q: How expensive would treatment cost?<\/p>\n
A: For treatment I think it's now, in dollar terms, something
\nlike US$650 to $700 per person a year, but that's lifelong
\ntreatment, and second, you have to add to that the cost of
\nlaboratory testing, monitoring, medical fees and so on.<\/p>\n
But that price has come down tremendously thanks to the work
\nof UNAIDS, because it used to cost over $10,000 per person per
\nyear, and that's still the case in quite a few countries. That's
\nthe price that we've negotiated with developing countries.<\/p>\n
Q: What do you think is specifically the Indonesian story of the
\nspread and prevalence of HIV\/AIDS?<\/p>\n
A: On the one hand, I think the story is a bit the same as in
\nother countries, but it has taken much longer in Indonesia to
\nstart off.<\/p>\n
Indonesia's been very fortunate that until basically two or
\nthree years ago there were very very few people infected with
\nHIV.<\/p>\n
I always thought that this was only a matter of time. Because
\nwhat has happened elsewhere is that once the virus is introduced,
\nfor example, among people who inject drugs and share needles,
\nthen you see a very rapid increase.<\/p>\n
And that is what has happened. It's always the most vulnerable
\n(group), the most at risk, who are going to be the first
\ninfected. And then it spreads to others who are a bit less at
\nrisk.<\/p>\n
What's specifically Indonesian with that I think, and we see a
\nbit of the same thing in the Philippines, is that it has always
\nbeen at a low level for many years. Will it go the same way? I
\nthink that's probably to be expected unless one invests far more
\nin education, awareness and openness.<\/p>\n
I think there is a bit of an illusion that so-called Asian
\nvalues will protect any country from a thing like AIDS. The
\nreality is that there can be a big difference between what the
\nofficial values are, or what you are supposed to do, and what is
\nactually happening.<\/p>\n
I think the power of Indonesia will be in the values that hold
\na strong community together, the family together, that could be
\nplayed out.<\/p>\n
The problem that I see is that the country is so vast --
\n(there are) few cities, and Papua is not Jakarta, it is not
\nSumatra, etc. -- so one would have to tailor the activities
\nagainst AIDS to the culture and specific region and all that.<\/p>\n
Q: Should the National Strategy be broken down to meet the
\nsituation of specific areas then?<\/p>\n
A: I think the principle is the same everywhere, a national AIDS
\nstrategy is important as the commitment of the government in the
\nfirst place.<\/p>\n
Second, to say what are the principles of the response, like
\nto prevent sexual transmission, transmission through the sharing
\nof needles. Third, it's a way of generating resources, money.<\/p>\n
But then the actual action plan will indeed be adapted to each
\nregion. I also understand that Indonesia's becoming more and more
\ndecentralized in terms of how business is done, even public
\nbusiness, so that means one will have to adapt it.<\/p>\n
Q: Why do you think the epidemic started off so slow in Indonesia
\ncompared to, for example, Thailand and Cambodia?<\/p>\n
A: I think it must have had to do with the behavior of people,
\nthe fact that probably in Thailand and Cambodia there is a far
\nmore flourishing sex industry. It's much more a part of their
\nlocal culture I think. It is about sexual behavior and about
\ninjecting needles. (At this point the interview is interrupted,
\nas Coordinating Minister for People's Welfare Jusuf Kalla has
\narrived for a dinner in which Piot is the guest of honor.)<\/p>\n
Q: As the executive director of UNAIDS, do you ever worry that
\nmembers of your own family might get infected with HIV?<\/p>\n
A: I have children who are in their twenties, and as a parent you
\nalways must be worried. But that's why it's important that we
\ntalk to our children. That's what I've done.<\/p>\n
We have been open about sexuality, and also include how they
\ncan protect themselves. And making sure that we talk about drugs
\nand so on. Making it discussable.<\/p>\n
That doesn't mean you have to sit down (to talk about it) all
\nthe time. I mean, because it's not easy, even for me. I can talk
\nabout this with the media, but when it's your own children its
\nalways more difficult. When it's your own parents it's also more
\ndifficult.<\/p>\n
But that's what I've done. I would not be credible
\n(otherwise).<\/p>",
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