Fight against AIDS everybody's responsibility

The United Nations Program on HIV/AIDS (UNAIDS) has warned that Indonesia is on the brink of an AIDS epidemic. The Jakarta Post's Hera Diani talked to visiting UNAIDS executive director Peter Piot about the issue.

Question: What concerns you most about the HIV/AIDS situation here?

Answer: There is leadership, good planning, strategy and all that at the national level. But these have yet to be translated into action in every province, every community.

I don't feel the sense of urgency that is required to make use of this opportunity to contain HIV.

Another issue that concerns me is the stigma. It takes much effort to overcome that, and it requires the involvement of the religious leaders, authorities, businesses and so on.

Not everyone here has access to treatment. I met people with HIV in Bandung, they said antiretroviral drug (ARV) access is very limited, and there is still discrimination on the side of the medical profession. That to me is difficult to understand, because they should be the first ones to help, instead of being judgmental.

How should we deal with religious leaders in particular?

There was a time when I considered religious leaders as one of our biggest problems in dealing with HIV/AIDS. But today I believe that they can be very strong allies.

In Iran, for example, there is a very strong program to deal with injecting drugs users (IDUs), a harm reduction program and all that, and it was fully supported by religious leaders.

In UNAIDS, one of our best sellers is a video cassette The role of Imam in the fight against AIDS made with the Islamic medical association of Uganda. In Senegal, which is a predominantly Muslim country, the Muslim leaders were really instrumental in the fight against AIDS.

Everywhere, there are spectrums of opinions from religious leaders who are more open, more tolerant and more, say, fundamentalist. What I see everywhere is that in all religions, the highest moral imperative is always preserving life. And second, the value of every human being. That should make for a better understanding of people living with HIV/AIDS, and ensure that it is the duty of everybody to fight AIDS.

I'm not asking for every religious organization or leader to agree on everything. The reality is people are not practicing abstinence, and we need to promote condoms because it saves lives.

At this point, what should Indonesia focus on?

Indonesia is in the early stages of an epidemic ... We see epidemics in certain populations: injecting drugs users (IDUs), sexual workers and their clients and among the heterosexual population in Papua.

The keys to direct prevention among people who are at highest risk are providing treatment and care for people who are infected, and general awareness among the population that HIV affects everybody. Do you think that with the problems of avian influenza, natural disasters, and so on, AIDS has been overlooked?

I understand that there is big competition with problems that are also very serious. And now, with avian flu, there is indeed a risk that AIDS will be overlooked. But we have no choice. We must deal with avian flu, but this does not mean we stop dealing with HIV/AIDS.

Do you think there has been a double standard, in the sense that a lot of funds have been channeled to avian flu while it is not yet an epidemic, unlike AIDS?

Avian flu needs serious attention because we don't know whether it will be an epidemic. Maybe there will never be one, we don't know for sure, but we can't take the risk. That's why we must be prepared.

But there are some double standards, for sure. Avian flu is something that will not be associated with shame and sins.

Some say that the ABC (Abstinence, Be Faithful, Condoms) strategy to prevent AIDS is a bit simplistic. What do you think?

Dealing with AIDS indeed is not simple. One of the things I've learned is that anything that has the word "only" does not work for AIDS.

ABC is a good basic strategy, I believe. But for many women it's pretty irrelevant. Many women, also in Jakarta, are infected from their infected partners or husbands. It's our partners' risky behavior that is as important as our own risky behavior.

So, what does ABC mean for women? Marriage is not meant by abstinence, for sure. Faithful, it has to come from both sides. Condoms, again, depends on the will and activity of the men. For women, we really need some other tools. But also, the behavior of men is fundamental.

There is criticism that rich countries do not give enough to help the poor ones deal with AIDS?

I certainly believe the rich countries could do more. But when I look at the situation, there is enormous progress. This year, in UNAIDS, we estimate that US$8 billion will be spent for AIDS in developing countries and half of that, $4 billion, comes from rich countries. When UNAIDS was created around nine years ago, only $200 million was spent on AIDS.

But I think it should be more, for sure. There is an international agreement that rich countries devote 0.7 percent of their GDP, but many have not reached that point. So, more could be done because the funding gap is still wide, particularly for providing access for treatment in the most affected countries.